The study was requested by Senators Charles E. Grassley, Republican of
Iowa, and John B. Breaux, Democrat of Louisiana.

They favor home and community care as an option under Medicaid, but
expressed alarm at the findings in the report.

"These waivers should be put on hold until the department gets a
handle on the quality of care going to older and disabled Americans,"
said Mr. Grassley, the chairman of the Senate Finance Committee.

"Right now there's no accountability, and that's wrong."

In a letter to Secretary Thompson, the senators asked the Bush
administration to submit a detailed plan for corrective action by July
28.

More than half the people receiving home and community care under
Medicaid waivers are 65 or older.

They receive all sorts of therapy, as well as assistance with bathing,
dressing, shopping and other essential activities they cannot perform
themselves.

As former governors, President Bush and Mr. Thompson have repeatedly
said they want to give states more control over Medicaid by speeding
the approval of federal waivers.

The Congressional investigators found "medical and physical neglect"
of some Medicaid recipients.

But they said the full extent of such problems was unknown, because no
one was enforcing basic safety and hygiene standards or systematically
reviewing patients' records.

Sara Rosenbaum, a professor of health law and policy at George
Washington University, said:

"States prepare good plans of care for Medicaid recipients, but
there's no follow-through to see if people get the care. States assume
that home and community care will save money, without realizing that
it takes real money to monitor the quality of care."

The Congressional investigators found "medical and physical neglect"
of some Medicaid recipients.

But they said the full extent of such problems was unknown, because no
one was enforcing basic safety and hygiene standards or systematically
reviewing patients' records.

Many states sign contracts with social service agencies to manage care
for Medicaid recipients, but never review the quality of care or
verify that services were actually provided, the report said.

In Oklahoma, it said, 27 percent of Medicaid recipients received none
of their authorized personal care services, and 49 percent received
only half of the authorized services.


From The New York Times, 7/7/03:
http://www.nytimes.com/2003/07/07/po...partner=GOOGLE

Report Criticizes Federal Oversight of State Medicaid

By ROBERT PEAR

WASHINGTON --

The Bush administration has allowed states to make vast changes in
Medicaid but has not held them accountable for the quality of care
they provide to poor elderly and disabled people, Congressional
investigators said today.

The administration often boasts that it has approved record numbers of
Medicaid waivers, which exempt states from some federal regulations
and give them broad discretion to decide who gets what services.

But the investigators, from the General Accounting Office, said the
secretary of health and human services, Tommy G. Thompson, had "not
fully complied with the statutory and regulatory requirements" to
monitor the quality of care under such waivers.

The accounting office examined 15 of the largest waivers, covering
services to 266,700 elderly people in 15 states and found problems
with the quality of care in 11 of the programs.

In many cases, Medicaid beneficiaries simply did not receive the
services they were supposed to receive.

The Medicaid beneficiaries were all eligible for nursing-home care but
chose to stay in the community with friends and relatives.

Rather than pay the high cost of institutional care, the states
promised to provide a wide range of social and medical services known
as home and community-based care.

The General Accounting Office said, however, that the states often
failed to provide those services and that the federal Department of
Health and Human Services took no action to protect patients.

__________________________________________________ _____

This is unforgivable and ghoulish.

Harry







The federal government and the states spent more than $258 billion on
Medicaid last year, with the federal share accounting for 57 percent.

Thomas A. Scully, administrator of the federal Centers for Medicare
and Medicaid Services, said in an interview that he was "not aware of
the extent of the problem."

In written comments included in the report, Mr. Scully said states
were responsible for "quality assurance."

For the federal government to review the quality of care provided
under every waiver, he said, would require a new investment of
millions of dollars and hundreds of additional federal employees.

In any event, he said, federal inspectors should not be marching
through private homes to evaluate care.

The study was requested by Senators Charles E. Grassley, Republican of
Iowa, and John B. Breaux, Democrat of Louisiana.

They favor home and community care as an option under Medicaid, but
expressed alarm at the findings in the report.

"These waivers should be put on hold until the department gets a
handle on the quality of care going to older and disabled Americans,"
said Mr. Grassley, the chairman of the Senate Finance Committee.

"Right now there's no accountability, and that's wrong."

In a letter to Secretary Thompson, the senators asked the Bush
administration to submit a detailed plan for corrective action by July
28.

The effect of a waiver is to exempt a state from certain provisions of
federal law and regulations.

Waivers allow states to provide services in selected geographic areas
or to specific populations and to limit the number of people served or
the total spent, actions not usually allowed under the Medicaid
statute.

For years, Medicaid favored institutional care.

Congress authorized home and community care as an alternative in 1981.

Since 1992, the number of Medicaid beneficiaries receiving such care
under federal waivers has tripled, to 800,000, and it is expected to
continue growing.

With waivers, states can tailor services to individual patients,
including those with Alzheimer's disease, traumatic brain injuries,
mental retardation and AIDS.

More than half the people receiving home and community care under
Medicaid waivers are 65 or older.

They receive all sorts of therapy, as well as assistance with bathing,
dressing, shopping and other essential activities they cannot perform
themselves.

In some states, the patients direct their own care, by hiring and
training their own workers.

Medicaid spending on such care soared to $15 billion last year, from
less than $2 billion in 1992.

As former governors, President Bush and Mr. Thompson have repeatedly
said they want to give states more control over Medicaid by speeding
the approval of federal waivers.

Sara Rosenbaum, a professor of health law and policy at George
Washington University, said:

"States prepare good plans of care for Medicaid recipients, but
there's no follow-through to see if people get the care. States assume
that home and community care will save money, without realizing that
it takes real money to monitor the quality of care."

The Congressional investigators found "medical and physical neglect"
of some Medicaid recipients.

But they said the full extent of such problems was unknown, because no
one was enforcing basic safety and hygiene standards or systematically
reviewing patients' records.

More than a dozen state waiver programs covering tens of thousands of
people have gone more than a decade without any federal review of the
quality of care, the accounting office said.

These programs were in Hawaii, Idaho, Iowa, Louisiana, Missouri, New
Mexico, Oklahoma and Texas.

As former governors, President Bush and Mr. Thompson have repeatedly
said they want to give states more control over Medicaid by speeding
the approval of federal waivers.

Sara Rosenbaum, a professor of health law and policy at George
Washington University, said:

"States prepare good plans of care for Medicaid recipients, but
there's no follow-through to see if people get the care. States assume
that home and community care will save money, without realizing that
it takes real money to monitor the quality of care."

The Congressional investigators found "medical and physical neglect"
of some Medicaid recipients.

But they said the full extent of such problems was unknown, because no
one was enforcing basic safety and hygiene standards or systematically
reviewing patients' records.


Maureen Booth, a health policy expert at the University of Southern
Maine, said the strengths of home and community care also complicated
the task of guaranteeing its quality.

"The beauty of home and community care is that it's flexible, it
responds to the needs of individual patients with a cadre of support
workers," Ms. Booth said.

"But to improve quality, you have to reach a whole myriad of workers
employed by multiple agencies."