State will no longer pay for hospice care

The cuts will only stop new patients from receiving Medicaid assistance.

Cheryl Charles-Jones, a medical social worker with St. Joseph Hospice in Thibodaux, comforts Mark Ledet on Friday at his mother’s home in Houma. Ledet, who is suffering from lung cancer that has spread to his brain, just moved back into his mother’s home while he receives care.
Chris Heller/Staff

By Matthew Albright
Staff Writer

Published: Sunday, January 6, 2013 at 6:01 a.m.

At the end of this month, poor Louisianans with terminal illnesses could have a much harder time getting end-of-life care.

The state Department of Health and Hospitals announced late last month that the state’s Medicaid program will no longer pay for hospice care.

The cuts will only stop new patients from receiving Medicaid assistance.

Patients who are already receiving hospice care under Medicaid will continue to get those services for the rest of their lives.

The cuts are a result of a $165 million budget shortfall the state must deal with by July. Gov. Bobby Jindal’s administration passed the brunt of those cuts onto the state’s health care system.

That caused the department to trim payments to doctors and hospitals and eliminate a host of programs.

The Department of Health and Hospitals estimates cutting hospice programs could save the department $nearly $3.3 million, $1.1 million from the state’s general fund. But local hospice providers said the cuts could leave the state’s poorest residents to face death without medical support and may hurt the state’s budget in the long term.

WHO GETS WHAT?

In Louisiana, Medicaid paid for hospice care of 5,189 patients in 2012, according to the Louisiana-Mississippi Hospice and Palliative Care Organization. Numbers for individual parishes weren’t available.

Cathy Bowen, administrator of St. Joseph Hospice in Thibodaux, said Medicaid hospice patients can be any age — sometimes children — and are usually younger than 65, the age when most Americans qualify for Medicare. She estimates 5-10 percent of her patients get Medicaid.

“These are usually people who were diagnosed with a terminal illness, so they lost their job and their health benefits,” she said.

Bowen said patients in hospice care generally have less than six months to live. The average hospice stay is about 72 days. while half of hospice patients die after 26 days in treatment, according to the Louisiana-Mississippi Hospice and Palliative Care Organization.

When Medicaid pays for hospice treatment, it usually pays for medicine, health equipment rental, diapers, dressings and other supplies and professional staff to help the patient and his or her family.

“Hospice care is for any disease where aggressive treatments are no longer going to help,” said James Ellis, a Thibodaux-based oncologist and hospice doctor. “This is purely supportive care to allow them to die with comfort and with their dignity.”

Ellis said the loss of Medicaid money could put some terminally ill patients in dire straits.

“These people are going to die in their homes without the support they need,” Ellis said. “You’ll be taking away their dignity and comfort. That’s not just for the patient but for the loved ones who are going to try to care for them without any help.”

HOW CAN PEOPLE COPE?

Department of Health and Hospitals spokesman Ken Pastorick emphasized that existing patients will keep their hospice care and said in an email that there are other ways for patients to find help using Medicaid.

“People who need hospice services after Feb. 1, both in nursing homes and in the community, will still be able to access many of the same Medicaid services they receive today,” Pastorick wrote.

Nursing homes provide the kind of care a hospice provides, he said. Those outside nursing homes will still be able to get the medicine they need through the Medicaid Pharmacy Program, and Medicaid will still pay for some home-health services.

Pastorick said there are other ways to get the kinds of services hospice provides.

“The emotional support services previously offered as hospice care in community settings through Medicaid are available through nonprofit and faith-based groups that provide these services at no cost throughout the state,” he wrote.

WILL COSTS BE CUT?

Many hospice providers worry some people will go without home care. In addition to the human impacts, local hospice workers said that could cause the money-saving plan to backfire.

“If the governor thinks these cuts are going to save the state money, I think he may be mistaken,” Bowen said.

Medicaid pays about $120 a day for hospice care locally, he said. If patients can’t get that care, they are often forced to go to the emergency room — at a much higher cost to the state.

Bowen is not the only hospice provider who feels the cuts could hurt the state’s budget.

The Louisiana-Mississippi Hospice and Palliative Care Organization estimates the state spends about $2,202 per Medicaid patient for a total of $11.4 million. In an email to hospice providers, the organization argued care costs a fourth of what the same treatments would cost in hospitals.
The group said there’s a troublesome precedent for eliminating Medicaid for hospice patients.

In 2009, the email says, Arizona eliminated its Medicaid Hospice Benefit. The state reinstated the benefit in 2010 after Medicaid costs rose by an estimated 4.4 percent.

WHAT’S NEXT?

Bowen said her hospice will try to keep providing services for patients who will be unable to pay without Medicaid.

“If you do hospice care, you’re doing it because you have a heart,” she said. “When you talk to these people and see what they’re going through, there’s no way you don’t do everything you can to get them that care.”

Bowen said St. Joseph has a nonprofit foundation that could help the hospice pay for some of the patients left without care. But any other expenses would have to come out of the hospice’s budget.

“We’re going to try to do everything we can to continue to provide this care,” she said.

Bowen said hospice providers are still working out the details of how the cuts will affect them and struggling to come up with a long-term plan to fill the gaps.

“We are still figuring out exactly what’s going to happen,” she said. “If a solution doesn’t come down, I think we need to start looking at how we can rally the community together to fix things ourselves.”

State will no longer pay for hospice care | HoumaToday.com

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