Connecticut Governor Ned Lamont has proposed ending the state’s Community First Choice program, which helps families access home care for people with disabilities, and replacing it with a waiver program.
WSHU’s Ebong Udoma spoke with CT Mirror’s Katy Golvala to discuss her article written with Laura Tillman, “‘Unbelievably cruel’: Advocates decry threat to home care program,” as part of the collaborative podcast Long Story Short. Read Katy and Laura’s piece here.
WSHU: Hello, Katy. Families of disabled state residents have been at the Legislative Office Building protesting Governor Ned Lamont's proposal to replace Community First Choice, the state's home health care program. Is that what prompted you and your colleague, Laura Tillman, to look into this?
KG: Yeah, absolutely. So families who participate in Community First Choice say that it is a way to keep their loved ones who the state has determined need a nursing home level of care in their homes. So these are people who require a nursing home level of care, but are able, through this program, to have that care happen at home instead. And they say that that benefits the participants, and that they get to stay home with their families, and it also benefits the state, because in general, home and community-based care is found to be more cost-effective than institutional care.
WSHU: So why, then, is the Lamont administration proposing replacing this program?
KG: Yeah, that's a good question. So this program is not capped, meaning anyone who qualifies for Medicaid and is in need of nursing home-level care can choose to enroll in this program if they would like to. And the Lamont administration is saying, you know, we thought that through the structure of this program and some federal dollars we were able to get back from it that it would save the state money, but actually, because enrollment has increased so rapidly, these costs are unsustainable for the state. So we need to replace it with a program that, like the other state programs for home and community-based care, caps the number of participants so that we can control the cost of this program and put those savings, potentially, into other home and community-based programs that the state has, that right now might not be getting the resources they need.
WSHU: Now, let's talk about the budget here, 40% of the state's Medicaid budget goes to home health care?
KG: So 40% of the state's Medicaid budget goes towards long-term care, whether that is happening in an institutional setting or whether that is happening at home. So you can see why the Lamont administration would be trying to address the larger issue of long-term care, because it is such a big part of the Medicaid budget.
WSHU: Now, the recipients are concerned that replacing this program will create lengthy wait lists to get home care. There are about 7,000 people who are served right now. What is the state saying, as far as that's concerned?
KG: So the state has been clear that people who are already in this program would get to retain the services that they currently receive. They do not want anyone to be under the impression that people who are currently getting care at home will be forced into an institutional setting. But this creates a wait list for future recipients of the program who might newly find themselves needing a nursing home level of care, who qualify for Medicaid, who might say, “I would, I would prefer to get that care at home,” whereas right now, those people would be able to make that decision and get that care at home. Under Lamont's proposal, they would have to go on a wait list before they could actually get the care at home. And what advocates are saying is that while they're on that wait list, they would likely have no choice but to go into an institutional setting, unless they're one of the very rare lucky cases where perhaps the family and friends can cobble together a way to care for them. But again, these are people who need, you know, some of them need 40 hours of care a week. Some of them need 24/7 care. And so that is very difficult outside of an institutional setting for their families to make up.
WSHU: Now you give the example of Alexi and Lorra Jorden, who receive personal care attendants in their homes. What do these personal care attendants do?
KG: Yeah, so these personal care attendants help Alexi get dressed and ready in the morning, and they help him with his communication. Laura even talked about how they're able to think about what kind of activities Alexi wants to do, and sort of structure the personal care attendant's time around those activities. So he really enjoys bowling, for example, and art, and so they're able to have those personal care attendants focus on those activities with him.
WSHU: Laura also had this quote that she said, “It's unbelievably cruel,” the proposal that the Lamont administration has come up with, and the feeling is that the state can afford this, because we're such a wealthy state. So where do we go from here? What's the situation right now? Is this a done deal? What are lawmakers talking about doing with this?
KG: Advocates fear that state officials are talking as if it is a done deal. It is not yet, you know, it is in the governor's proposed budget, which will have to be voted on, and there are, I think, legislators who are taking advocates' concerns extremely seriously. We saw Commissioner Andrea Barton Reeves testify in the Appropriations Committee, and several of the legislators in that committee pushed back a bit and asked her, you know, we know how important home care is to people, and they had heard from several very concerned constituents about the governor's proposal. So I think advocates are going to continue to fight, and we will have to wait and see where things end up.
WSHU: I think what underscores this whole argument that they're trying to make, the advocates are trying to make, is that they spent the past year being concerned about cuts from the Trump administration, and now they're getting a cut from the Lamont administration that they were not expecting.
KG: That's right, and I think to be fair to the Lamont administration, what they would say is no one who currently gets these services is going to experience a cut. But advocates are concerned that they're concerned for future participants, and they are also concerned that that might not be entirely true, so we'll have to wait and see.
