Restoring Funding Cuts For Home Care May Not Pass

by Bob O’Toole, President Informed Eldercare Decisions, Inc.

According to the Associated Press (September 19, 1998), Legislation to restore $1.4 billion for Medicare home health benefits cut by congressional budget writers last year faces an uncertain fate because Republicans and Democrats cannot agree on the money's source.

"I have serious misgivings about a bill that isn't budget-neutral," said Sen. Charles Grassley, R-Iowa, chairman of the Senate Special Committee on Aging.

Trying to stem the growth of Medicare's home health program, lawmakers last year agreed to new limits on what some said was out-of-control, potentially fraudulent use of the benefit.

But home care companies contend the cuts were too deep. Also, some elderly and disabled Medicare beneficiaries say they are not getting the care they need. The new annual caps on payments to home care companies were meant to save $1.6 billion this year alone. In the past, companies were paid for every visit, virtually without limit.

The House Ways and Means Committee, in a bipartisan voice vote Friday, agreed to legislation to restore $1.4 billion to the program over five years.

But they could not resolve differences over how to pay for it, diminishing prospects that the rest of the House, not to mention the Senate, can reach agreement on the matter before next month, when Congress is scheduled to adjourn for the year.

Democrats want to preserve expected budget surpluses to shore up the Social Security system. They suggested scaling back a Republican favorite: tax-free medical savings accounts for senior citizens, scheduled to be available on an experimental basis starting next year. But the GOP quickly rejected that suggestion.

Another idea, to make Medicare beneficiaries pay part of the cost of each home care visit, is backed by Rep. Bill Thomas, R-Calif., but few lawmakers from either party support it.

Congress has ordered up a more precise payment system that was to be ready by next year, but it has been delayed while Medicare struggles to fix computer problems caused by the year 2000 glitch.

Meanwhile, auditors with the General Accounting Office -- Congress' investigative branch -- examined the situation in August and found that despite the new payment caps, the number of home health care companies serving Medicare beneficiaries has continued to grow.

At the same time, however, the auditors found that people with serious conditions requiring expensive care have had more trouble finding it.