Cutting Medicaid Hospice Benefit Would Cost Florida More, Put Neediest Individuals at Risk

Wednesday, December 31, 2008 General News
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TALLAHASSEE, Fla., Dec. 30 The State ofFlorida's proposed elimination of the Medicaid benefit that provides hospicecare to some of the state's most fragile individuals actually would costFlorida millions more than the state currently spends - adding to the state'sbudget deficit rather than reducing it - according to a newly released studycommissioned by Florida Hospices and Palliative Care (FHPC), the statewidegroup representing all of the state's hospice providers.

FHPC engaged The Moran Company, a Washington-based health care researchand consulting firm, to examine the state's financial assumptions and developan independent evaluation of the impact of eliminating the Medicaid HospiceBenefit, as recommended by Florida's Agency for Health Care Administration(AHCA). The study reviewed actual state data for fiscal year 2007 andconcluded that if the cut had been in place at that time, the state's healthcare budget would have been $3.7 million more. In contrast to the findings ofthe Moran Company report, AHCA claims cutting the benefit for fiscal year 2009would save the state $343 million in Medicaid payments.

FHPC Executive Director Paul Ledford said, "This report reinforces ourview that Florida can't afford to take this misguided approach to dealing withits budget difficulties, especially since it will only make the budgetsituation worse. Cutting the Medicaid Hospice Benefit doesn't mean the needsof the terminal patient change; it just shifts those costs to more expensiveways of delivering those vital services.

"We appreciate the financial challenges that Florida's government faces,but cutting the Medicaid Hospice Benefit simply isn't the answer - or even apart of the answer," Ledford added.

The report contained the following major findings:

-- Eliminating the Medicaid Hospice Benefit will not save the state money,and likely will result in increased spending for mandatory services. Thereport conservatively estimates an additional $3.7 million in state Medicaidcosts, as patients needing end-of-life care would end up in more expensivesettings, such as hospital emergency rooms.

-- Such action also will likely increase the burden on Florida counties toprovide indigent care through already financially stressed indigent careprograms.

-- The loss of the service coordination, care management, and supportiveservices offered by hospice will increase fragmentation of care for terminallyill patients, limit their access to palliative care, and burden families andcaregivers, potentially limiting their employment and educational options.

-- The beneficiaries in Florida's Medicaid hospice program are differentfrom the Medicare population that dominates hospice services. FloridaMedicaid-only hospice patients are younger and more likely to be in theterminal stages of cancer or have HIV/AIDS related conditions than Medicare ordual Medicare/Medicaid patients. Their average length of stay in hospice isshorter, and their care is more likely to be complex and involve management ofsevere symptoms that, unmanaged, trigger emergency room visits and/orhospitalization.

-- The cut also would mean that Florida will lose revenue. For everydollar Florida cuts in the hospice benefit, the state will lose $1.25 inmatching Federal Medicaid support.

The research study also noted that, until now, every other state that hasstudied wiping out the Medicaid Hospice Benefit has rejected that approach forprecisely the same reason - it ends up costing more money than would be"saved." In fact, Connecticut recently added the benefit, and now only twostates do not offer it.

"Hospice has a vital place in health care," noted Anthony J. Palumbo, FHPCPresident and CEO of Hospice of Citrus County and Hospice of the Nature Coast."In addition to the compassionate, hands-on medical care we provide, we alsotake care of our patients' psychosocial and spiritual needs. We care forpatients as well as their loved ones."

"Hospice is an all-inclusive benefit," Palumbo added. "Every visit by ournurses, hospice aides, social workers, chaplains, physicians andcommunity-based volunteers is covered by a per diem payment that is widelyrecognized as cost-effective. And, from that same small per diem payment,hospices provide patients - without charge - all of the prescription drugs,over-the-counter medications, medical equipment and medical suppliesassociated with a patient's primary diagnosis. Hospices also offer bereavementcare to each patient's loved ones for up to a year after the patient has died,all at no additional cost to the health care payment system."

SOURCE Florida Hospices and Palliative Care

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