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Despite waiting list, Medicaid waiver program has surplus

CHARLESTON, W.Va. -- Despite having more than 1,000 senior West Virginians on a waiting list for in-home-care services for the elderly and disabled, the Department of Health and Human Resources finished the 2011-12 budget year with an $11 million surplus left over from the $44 million the state had budgeted for the program.

DHHR Deputy Commissioner Cindy Beane told legislators the money was left over because, under federal regulations, once a slot becomes open for an Medicaid Aged and Disabled waiver -- either because the recipient has moved out-of-state, has been moved into a nursing home, or has died -- it cannot be filled until the next budget year begins on July 1.

House Health and Human Resources Chairman Don Perdue, D-Wayne, called those requirements confusing and frustrating -- particularly since the unspent $11 million could have covered the costs of in-home care for more than 450 senior citizens on the wait-list.

"All of us get calls every day from persons who want these services and can't get them," Perdue said, "and then we report that there is a surplus."

With costs for the in-home-care services increasing and federal matching funds on the decline, the Tomblin administration capped the Aged and Disabled waiver program at just over 8,100 slots in December.

Currently, there are 1,053 older West Virginians on the wait-list for the waivers, to provide them with personal care, meal preparation, housekeeping and transportation they need in order to remain in their homes, Beane said.

In the past budget year, 28 seniors died while on the wait-list for in-home care, while 42 others were placed in nursing homes, she added.

During the course of the 2011-12 budget year, more than 1,000 Aged and Disabled waiver slots opened up. That included 607 recipients who died, 157 who were moved into nursing homes, and 287 who lost eligibility, moved out-of-state or otherwise opted out of the program.

However, under federal Centers for Medical Services regulations, none of the open slots could be filled with new participants until the new budget year started on July 1.

"That is where a lot of people have a lot of confusion: 'Why can't I put someone else in that slot?'" Beane said.

It would cost about $25 million a year to expand the slots in the waiver program to eliminate the current wait list, with the state's share totaling about $7.2 million, she said.

Also during Tuesday's meeting of the Legislative Oversight Commission on Health and Human Resources Accountability:

• DHHR acting secretary Rocco Fucillo said the administration is hiring an independent actuary to analyze the costs and benefits of expanding eligibility for Medicaid coverage to households with incomes of up to 138 percent of the federal poverty level, under the federal Affordable Care Act.

Under a U.S. Supreme Court ruling upholding the federal law, but giving states the option to participate in Medicaid expansion, states have to decide whether to opt-in when expansion begins in 2014.

Sen. Dan Foster, D-Kanawha, stressed that the actuary, who is being retained through a contract with the state Insurance Commission, needs to weigh the costs as well as the benefits to the state.

"There are a number of folks who believe the Medicaid expansion will actually save the state money," Foster said.

• DHHR officials said they are still evaluating bids for a contract potentially worth $100 million to upgrade the state's Medicaid Management Information System, the mega-computer system that processes Medicaid billings and payments.

• About 9 percent of the 6,100 full-time positions in the DHHR are vacant at any given time, DHHR officials said. Legislators requested data to determine how that vacancy rate compares with other state agencies.

Reach Phil Kabler at philk@wvgazette.com or 304-348-1220.


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