A Mobile Register Letter to the Editor
I’m Nick Dupree. Some of you may remember me from my public battle to stop Alabama Medicaid from ending nursing care for people on life support when they turned 21, a battle I won and received a flurry of media attention for three years ago, in the Register and across the nation. My “victory” has extended coverage for approximately six Alabamians.
Any other disabled adult who needs care has little to no options if they want to remain in the community. Even if they could get on one of Alabama’s home care programs in this age of decade-long waiting lists and enrollment caps, they could, at most, get only several hours of care per day. Everyone else is given no other choice but a costly nursing home. Alabama, like many states, spends over 3/4 of their long-term care budget on institutions even though it is more expense than home care. And despite the fact that every survey and study on the subject has shown that institutions are the last place people with disabilities want to live vs. remaining in their homes, it remains the preferred option for a government heavily influenced by nursing home owners’ campaign contributions.
Advocates like myself have been speaking out in response to the institutional bias so entrenched in our system, and we’ve gotten some results in Washington. In July, the federal Center for Medicaid Services (CMS) announced a new “Money Follows the Person” rebalancing project. The Feds are prepared to pay states an enhanced 12-month 84.76% funding match to give citizens the option of freedom in their community instead of the walls of a nursing home. “With new federal funding,” CMS Director McClellan said, “there is no longer any excuse for the status quo.”
In his recent letter to the disability community, Governor Bob Riley does give an excuse for the status quo: it may cost the state more money later. While 38 other states so far have lined up for the new federal money, Riley and Alabama Medicaid have remained steadfast in their refusal to apply for this new grant. See, in Alabama’s current system, big institutions get Medicaid dollars per bed, whether they’re occupied or not. So if Alabamians leave nursing homes for new services in the community, the explicit goal of the CMS rebalancing grant, Alabama will still be giving the nursing homes their cut anyway.
Not accepting federal funding to begin to correct this, and circling the wagons to protect the current inequitable boondoogle is simply inexcusable. Home care instead of institutional care would not make government bigger; the opposite is true. Community-based services allow people to thrive at home at less cost, and it makes them the responsibility of family, friends and neighbors instead of big government nursing homes notorious for abuse and neglect.
Thursday, advocates will be rallying at the Capitol steps in Montgomery to demand Governor Riley do the right thing and accept the new federal funds. It would be especially henious for the Governor to shirk his responsibility for Alabamians with disabilities during this time of record budget surplus. Even the Pharaoh of Genesis 41 did not refuse those in need in the times of Joseph’s planned surplus. We can do the right thing. I urge all readers to speak out and implore the Governor; life in Alabama does not need to remain difficult and inhumane for most of our disabled citizens.
Nick Dupree
Filed Under: Health care and Disability Rights