If you are a caregiver for an elderly person or a disabled adult, chances are your family member receives services paid by the Medicaid Program. Medicaid provides services to a lot of middle class families that after using all of their savings still need services in the home, in an assisted living facility or in a nursing home. You don’t have to be indigent to qualify for Medicaid, and this is why it is so important to make sure the program is protected from policy changes that will impact the ability of the middle class to access home and community based services.

While the name Medicaid may or may not appear in the documents you have been asked to sign or in the case plan your care manager has given you, money to support Respite, Home Health, Counseling, Transportation and Personal Care is coming from the State Medicaid program. This is particularly true if you are a client of the Consumer Directed Care program.

Medicaid is the third leg of security that could disappear unless we begin to defend the program by asking candidates running for office what is their position on the program now before they get our vote. I said we need to know their position now because efforts to silently ration long term care to the most vulnerable people in our society are on the way at this time affecting the safety net we Americans have been building for years.

The third step in the plan to dismantle the aging service provider network will begin in January, 2005 when a group of Governors will call for the Modernization of the Medicaid Program. Modernization is a term that lately has been used as a euphemism for realigning services and funding to community based programs. This realignment is done in a way that modifies eligibility criteria reducing by default the number of elders and disabled adults eligible for services. The Governors proposing the changes hope that the ultimate outcome will be a much smaller Medicaid budget. Elected officials are saying that the impact of the Medicaid budget at the state and federal levels is the driving force in state and federal deficits therefore something must be done now before the baby boomers enter the picture. The leadership for the Medicaid Modernization plan will come from lame duck Governors who technically have nothing to lose from their actions.

Why, you may ask, do I need to worry about changes to the Medicaid program, my family member is already eligible, so nothing can change his/her eligibility status. Unfortunately, that is not necessarily the case. When a program changes eligibility criteria one of the options is to make those eligibility criteria retroactive, another option is to make the new criteria effective the date the legislation was passed and the third option is to make the new regulation effective at a future date. While it is very possible the modernization plan may include a future date for implementation, it is also very possible that agencies responsible for administering the program may begin to change eligibility criteria immediately due to lack of funding to support the Medicaid program in its present condition, and regardless as to whether or not the law indicates a future date government entities may begin to concentrate on those frail elders with the highest degree of impediments.

Few caregivers are aware that the eligibility criteria to qualify for a Medicaid waiver program is a minimum of 3 impediments in the activities of daily living or a combination of impediments in the activities of daily living and the instrumental activities of daily living. The person doing the assessment may decide that due to limited funding instead of including the names of every frail person with 3 impediments in a waiting list, they may concentrate in only including the name of those individuals with 4 or 5 impediments in the waiting list. This modification will ration access to care. This is already being done and it is the main reason the total number of elders and frail individuals in need of services is so elusive that not even the media can identify them.

Elected officials have been preparing the public for such drastic change in the Medicaid program. Reporters are already capturing stories of how the Medicaid budget is driving both the federal and the state budget and how this is going to eventually bankrupt the nation. The truth is that the trillion dollar deficit is really not connected to Medicaid or Social Security, but to the war effort. The message that is being disseminated in preparation for the big change in the Medicaid program is that families must take care of family members by accepting the family responsibility in all frailty cases. What the message is not saying is that for some families this responsibility is welcome but not all the families are able to do it alone or do it for years and years without help from others.

Another change that has been introduced without a lot of public notice is the fact that programs are now being evaluated based on the number of caregivers that keep providing services to the family members with the same government help regardless of increase in frailty. This program evaluation does not measure the quality of life of those caregivers or assess the physical, emotional or financial limits of the caregiver.

The only reason the modernization of the Medicaid program has not begun this year is the fact that this is an election year. As such, no politician is willing to risk drastically changing a program that benefits so many caregivers and families. . This is the only program available to help families with long term care needs and you don’t have to exhaust all your resources to qualify for services. If the program is modernized chances are the Middle class will be the one most impacted. If the eligibility criteria for frailty level and income is changed, chances are more family members would have to leave their place of employment to take care of their loved one at home, representing an enormous sacrifice for the rest of the family.

We have a window of opportunity to fight for the preservation of the Medicaid program. If you don’t ask the candidates what is their position on the program, you may be risking losing the services your family member receives now or the potential services they may need in the future.

Dr. Gema Hernández


  • Dr. Gema G. Hernández, the founder of Aging & Cultural Consultants, Inc. and Access Ready: Communities for Life program is the former Secretary of the Department of Elder Affairs in the State of Florida, a professor and management consultant to many organizations nationwide and a caregiver for her parents for 18 years.br>
    Dr. Hernandez established Aging & Cultural Consultants, Inc. consulting firm to provide alternatives to nursing homes and to facilitate the creation of an elder friendly environment nationwide in which the private corporation understands the unique needs of its mature customers and uses that knowledge for entrepreneurial ideas to expand their businesses and to carve a niche for their companies in the mature adult market.