Restructure personal care services for savings

Democrat and Chronicle, August 16, 2010

As court and state agencies look into a dispute between Monroe County and a local advocacy agency for the disabled, a review of Medicaid spending is in order.

After all, $17 million of Medicaid funds are being used to pay for personal care services provided in Monroe with the assistance of the Center for Disability Rights.

Saying CDR’s ineptness posed a threat to the agency’s disabled clients, the county abruptly announced termination of its contract with CDR. A court review of the termination is scheduled for later this month, and this page has urged the state comptroller and state Health Department to get involved, too. CDR coordinates Medicaid funds used to pay attendants assigned to disabled clients. That’s part of $2 billion spent statewide for personal care.

What’s particularly troubling is that surveys show that New York, which has the most expensive Medicaid program in the nation at nearly $50 billion annually, spends an average of $25,000 on each personal care client. That’s a whopping 234 percent of the national average. Surely the state can bring down those costs.

Interestingly, CDR earlier this year proposed to Gov. David Paterson more than $200 million in statewide personal-care savings. A Paterson spokesman, however, said CDR’s recommendations had too many “overly aggressive assumptions.”

Another proposal by a think-tank that would cap personal-care hours at an average that is 150 percent of the national norm for a $480 million a year savings was similarly assessed.

And the governor’s own proposal for a $30 million a year savings in personal care was killed by the Legislature.

State lawmakers know that personal care is less expensive than institutionalized care. But that doesn’t mean more savings can’t be found. Most other states figured that out long ago.