In-home Health Care Will Suffer With TennCare Cuts

News of TennCare’s budget-tightening methods will arrive at about 1,000 mailboxes statewide early next week, informing clients that their in-home nursing care is being reduced or eliminated.

Evelyn Human, a Jonesborough, Tenn., woman whose 24-year-old son, John, has severe cerebral palsy, said Wednesday she is afraid she may lose the around-the-clock care currently provided.

“If he was forced into a nursing home, he wouldn’t last very long,” she said. “He needs someone around all the time. I work. But when I get home, all my attention is on John.”

TennCare will continue to cover people who are “energy dependent,” meaning members who require either a ventilator or tracheotomy to breathe. In this case, TennCare would cover up to the same costs a nursing home would charge to care for the person, said Marilyn Wilson, TennCare spokeswoman. 

John Human does not qualify as energy dependent, though he requires constant care.

“I wouldn’t put him in a nursing home,” said Evelyn Human. “He would die in there. They [TennCare] want me to just quit my job and go on welfare? It’s not fair. I know TennCare might come out and assess the situation a little closer. But I know their rules. I don’t think its right.”

Adults who don’t have such conditions could still receive up to 35 hours of help per week, of which no more than 27 could be filled by a skilled nurse, Wilson added.

“But frankly, some people are going to have to assess their situations,” she said. “If someone lives alone and requires round-the-clock care, for example, they may need to make some changes.”

The changes made in this year’s state budget restrict the amount of nursing and home health services that new patients can receive at home. Current TennCare home health patients could also see the number of hours of nursing services reduced.

The policy officially takes effect June 30, 2009, the last day of fiscal year 2008-2009.

Last week, TennCare budget cuts drew the ire of five county ambulance service officials who held a news conference to announce displeasure with $11.4 million in recent state budget cuts to EMS transportation funding.

They say the cuts could affect service and burden local taxpayers by forcing them to pay up to continue efficient service.

Meanwhile, Wilson said the state is monitoring the process and will carefully review the cases of people who move into institutions after their home health services are cut.

“There are about 10,000 people that currently have access to home nursing services, and we’ve already notified our entire adult population of the changes,” she said.

The Tennessee Home Care Campaign, a Nashville-based nonprofit health-care advocacy group, has organized events over the next few days to inform the public of the changes.

“What people may not know is that they will have only 10 days to appeal TennCare’s decision,” said Susan McKay, the group’s spokeswoman. “We are advising all people that get this letter to appeal and to ask for a face-to-face interview with an administrative law judge. The patients themselves are most likely not to know which way to turn.”

Legislators this year passed the Long Term Care Community Choices Act of 2008 aimed at adding patient choices of in-home and community-based services. The act was meant to reduce costs of home health care and to make sure people were treated humanely and not forced into nursing homes.

“There were committees formed, and we thought they were beginning to gain some ground on this,” McKay said. “We’re saying, ‘what’s the rush here, let’s give this bill a chance to work.’ We’re perplexed why this [reductions] is happening so fast. There’s virtually no alternatives for many of these people.”

Wilson confirmed that people can appeal the decision. However, the appeal must be based on a factual error.

“If they believe the change is going to make it hard for them – that is not a valid reason for an appeal,” Wilson said. “Your time is much better spent talking with your health-care providers and family members.” 

In 2000, TennCare’s budget for in-home nursing services was about $18 million. That grew to $243 million in fiscal year 2007-2008 thanks to a 53 percent annual growth rate.

Wilson said TennCare would have had to ask the state for more than $300 million just to maintain the same level of service for one year.

“It was clearly unsustainable,” she said.

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