The spouse as caregiver bill, S. 2277 died in the final hours of the legislative session on Beacon Hill on July 31. The House leadership decided to keep the bill stuck in House Ways and Means, rejecting the efforts of several House Committee Chairs to pass the bill that sailed smoothly through the Senate a couple of week earlier on a 39-0 Senate vote.
The one sentence bill would have allowed spouses to join the list of family members who can currently be paid to be a Personal Care Attendant (PCA) or Adult Foster Care provider.
The bill was never openly discussed or debate in the well of the House chamber. The House simply did not take the measure up. It was opposed by at least two key members of the House leadership team—more than enough to seal its fate. Bill proponents said the potential cost of the bill was one issue used to discredit the bill. But lawmakers warning of cost implications had no hard numbers as evidence, only conjecture.
Mass Home Care checked with state officials in Oregon, which has offered a spousal pay program for ten years now. Jane-Ellen Weidanz, who manages Oregon’s Spousal Pay program for Medicaid, told Mass Home Care her group did not see any significant increase because:
1. These individuals are eligible for our in-home services and would receive more hours if they had not chosen their spouse.
2. If the individual was not able to select their spouse, most of them would choose another in-home provider or end up in a licensed care setting.
3. The eligibility criteria is much more stringent than our average consumer. (Individuals must have more ADL needs and have a progressive illness)
We typically have between 80-150 individuals out of more than 12,500 individuals receiving in-home services. With the policy changes, we expect to have the number go up but don’t think it will change the costs compared to other service choice.
We also have a State Plan J, Independent Choices Program. We cash out consumers and they purchase their services from whomever they choose, including spouses. Even with this program, we have not seen a significant increase. ICP has about 350 individuals and only a subset of those pay their spouses.
“The arguments against this bill,” explained Al Norman, Executive Director of Mass Home Care, “which were passed on to us third hand, were completely undocumented.” Norman said there is no evidence at all that spouses as caregivers costs more in any of the 17 states that have gone ahead of Massachusetts to pay spouses.” A number of states have allowed spouse to be paid under a “cash and counselor” waiver with the federal government, which is done a “revenue neutral basis.
Norman said lawmakers give home care no credit for lowering the use of nursing facilities by 33 percent since the year 2000. “We save state and federal taxpayers $700 million annually due to the drop in MassHealth patient days at skilled nursing facilities,” Norman explained. “There are few state services that begin to save money immediately, because every day we keep someone out of a nursing facility bed, is a day we save money. We call that the home care dividend,” Norman noted. There are about 30,000 MassHealth members in the PCA program today, plus 8,000 people in Adult Foster Care.
Mass Home Care considers a bill giving consumers more caregivers to choose from is a civil rights bill, because the goal of MassHealth is to help members to live “in the least restrictive setting.” Many married couples have no children, or their children live far away. Not giving these members their full range of caregiver choice is compromising their civil right to live in the most integrated setting possible
Norman said the House blockage of the spouse bill hurt thousands of low-income married families across the state. “We should be passing family friendly laws,” Norman concluded. “The House is sending the message that married couples on MassHealth who want to care for each other should get divorced instead.”
Advocates vowed to file the bill again in the next legislative session, which begins in January 1, 2015, and to get the bill to the governor’s desk.