Remember when they used to talk about "Compassionate Conservatism"?
Bobby Jindal's state government in Louisiana will end Medicaid hospice care service for terminally ill poor patients. The intent, of course, is the Great Holy Cause of Cutting Spending — though it's likely that a number of those folks will end up going to the hospital instead, costing the state even more money.
But, on the bright side (from Gov. Jindal's perspective, one assumes), without care, or without receiving care with family around them, maybe those terminally ill poor will die faster, and so "decrease the surplus population" (and Medicaid rolls).
(h/t +Wendy Cockcroft)
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End of month will be end of hospice care for some Louisiana patients
Starting Feb. 1 Louisiana will stop offering hospice care services to most patients on medicaid.
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I can't figure out the budgetary issues on this.
"The Louisiana Department of Health and Hospitals say the elimination of hospice care for medicaid patients will mean nearly $3.3 million in savings this year alone. In 2014, it'll mean $8.3 million in savings."
If the state were paying hospice fees for privately insured individuals, then the private insurers would be stuck with the higher costs for hospitalizing people instead of having them in hospice. But since this is Medicaid, wouldn't the hospital costs just go back to the Department?
I'll need to find the Department's documentation to see how they calculated savings.
At a guess, they are just looking at the initial savings, and not factoring in some of those people actually going to the hospital. Which seems stupid (or disingenuous), but …
Maybe they'll just feed 'em to the alligators – that would be a lot faster and save a lot of money.
Ah, the FAQ at http://new.dhh.louisiana.gov/index.cfm/subhome/1/n/331 has a partial answer to this funding question:
"In the previous fiscal year, there were 5,819 recipients of hospice services through Louisiana Medicaid. Of those, 4,456 (76.6%), of those received the services while residing in a nursing home, of which 4,077 were Medicare/Medicaid dual eligibles and 379 were Medicaid only. Only 1,363 (23.4%) received the services in their homes, and this population is comprised of persons with Medicaid only."
"This should have no effect on the services received by people who have both Medicare and Medicaid (dual eligibles). Dual eligibles will still be able to receive hospice services paid for by Medicare."
So for the dual eligible population, the hospice cost gets shifted off of Medicaid and is shifted to Medicare, which presumably makes some difference.
Here's their response to "but won't they end up costing more in hospitals?" argument (again, costs are shifted off of the state books and to nonprofits such as clergy):
"Going forward, people who would have sought hospice care, either in a nursing home or community setting, will still be able to access most of the same services they receive today. For recipients in nursing homes, these facilities provide around-the-clock care to residents to help them stay comfortable, and many of these homes have established relationship with clergy members or nonprofit organizations who can provide emotional and spiritual support to residents. For those outside of nursing homes, they can still access services such as prescription drugs, home health and long term care personal care services for comfort and palliative care. The emotional support services previously offered through hospice can be accessed through community nonprofit and faith-based organizations."
So in the first case (who become (in)eligible, it appears the answer is, "We'll just make them rely on Medicare." They cost just as much (presumably), but the Feds end up paying the whole basket (vs. Medicaid which is a combo of state and federal funding).
For the 1,400 + 380 who are Medicaid-only … it appears they are out of luck.
In the second response you mention, +John E. Bredehoft, it appears the answer is, "Well, we're sure someone else will pay for it. If they're already in a nursing home, then the home will, I'm sure, provide charitable hospice care."
Well then. Glad that hospice care was unnecessary because the Feds and the community were always willing to pick up the tab. Makes you wonder why the state had to be involved in the first place. (Rolls eyes.)