As the nation prepares to mark the 20th anniversary of the Americans with Disabilities Act next week, the New York Times presents disturbing evidence that cash-strapped states are dismantling home-care services that have been helping elderly people and those with disabilities to live in their communities.

Since the start of the recession, at least 25 states and the District of Columbia have made sharp cuts in programs that, ironically, have been demonstrated to save states money because they keep people out of nursing homes.

“The situation is grim, and it’s safe to say that present trends are expected to continue,” said JoAnn Lamphere, the director of state government relations for health and long-term care for AARP. “Nearly every state has proposed cuts of some sort to Medicaid. Some might seem small, but it’s death by a thousand slashes.”

… Bruce Goldberg, director of the Oregon Department of Human Services, said the agency did not have an estimate for how many of the people losing home care would end up in assisted-living facilities or in nursing homes – or, if they did, how the state would pay for them.

“We’re in new territory,” Dr. Goldberg said. “Long-term care is a cobbled-together system with many holes, and they just got deeper.”

From the Wall Street Journal:

Around the country, shrinking state budgets and rising health-care costs are forcing drastic cuts in home services to people with disabilities. Because federal mandates restrict what states may cut inside Medicaid, states are often cutting basic services that help people with disabilities remain in their own homes.

This is happening even though home services are cheaper and more cost effective than institutional care. Experts say it’s politically easier to cut back individual services to people at home than to close a 24-hour facility. But many worry that the cuts could push more people into costly institutions or large group homes because that is where services are guaranteed.

“My biggest fear is having to go to an institution,” says Jimmy “Chip” Eubanks of Clinton, S.C., who has cerebral palsy and lives at home.

People with intellectual and developmental disabilities are particularly at risk for service reduction, experts say, because the per-person cost of their services is about 10 times higher than that of the average Medicaid recipient.

The cuts for the developmentally disabled are almost certain to bite deeper in the future. Part of the federal stimulus money this year was designed to prop up Medicaid. The federal infusion disappears for the fiscal year starting in July 2011.

Some of the biggest cuts are coming in South Carolina, where Medicaid already consumes about 20 percent of the state’s budget and is one of its fastest growing costs. In Aiken County alone, more than 5,000 people languish on waiting lists for various services. “We want to give families hope to keep their family unit together, but in reality there is very little we can put in place to assist them,” says the head of the county’s disabilities board.

From Topeka Capital-Journal,  AP/ABC News:

An estimated 600 people with disabilities and their allies rallied at the Kansas state Capitol Wednesday in a show of support for social services and higher taxes, saying legislators have a responsibility to protect people who are vulnerable. Hours later, an opposing group of about 300 rallied against tax hikes.

The disability advocacy rally was the culmination of a monthlong “Walk a Mile in My Shoes” relay across the state organized by InterHab Inc., a network of service providers.

Bill Craig, president and CEO of the Paola-based Lakemary Center, said the waiting list for people with developmental disabilities seeking services [in Kansas] now exceeds 4,000 and continues growing. At the same time, he said, people providing care to those with developmental disabilities hadn’t seen regular cost-of-living pay raises even before having their pay cut 10 percent because of Medicaid cuts.

“We struggle to keep up with local fast food restaurants as employers,” he said.

Kansas legislators face a $510 million budget shortfall for the coming fiscal year. Democratic Gov. Mark Parkinson is seeking to raise taxes to prevent budget cuts.

From the Lawrence [KS] Journal-World, WDAF Kansas City, KWCH-TV Kansas City:

Kansas disability rights advocates pleaded with state lawmakers to roll back a planned 10 percent cut in Medicaid funding, saying that the $22.7 million reduction would put the lives of vulnerable people at risk.

At a Capitol news conference Friday, advocates said the proposed cuts would end up costing more because they would force the state to place people in more expensive nursing homes.

“It’s just mind-boggling that we would cut those services only to force people into institutions which are going to cost taxpayers more dollars,” said Rocky Nichols, executive director of the Disability Rights Center of Kansas.

He said policymakers don’t understand that the cuts “are real and are devastating people’s lives, and without restoring those cuts, it’s only going to get worse.”

From UPI:

A new study in the journal Pediatrics (free article) found that the financial impact of raising a child with a disability varies widely between states, depending on each state’s Medicaid and State Children’s Health Insurance Program. The study also found that low income families spend a disproportionally large share of their income on their child’s care.

“Policy makers should consider ways to strengthen Medicaid and the State Children’s Health Insurance Program (SCHIP) to reduce the financial burdens these families shoulder,” said Paul Shattuck, a professor of social work at Washington University in St. Louis and one of the study’s authors.

See also:

Wide variation in state Medicaid and SCHIP policies determine financial burden for low-income families with special health care needs children (with video) – Washington University in St. Louis News and Information

From the New York Times:

Enrollment in Medicaid is climbing to record highs, prompting grave concerns among the states about the future of the government health insurance for poor people and those with disabilities, according to a survey released Wednesday.

An annual survey of state Medicaid directors, conducted by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured, found enrollment growing by an average of 5.4 percent in the previous fiscal year, the highest rate in six years. Eight states reported increases of more than ten percent.

… state officials are already panicking about how to compensate when the spike in federal matching funds expires at the end of 2010. Few anticipate any significant reduction in their Medicaid rolls by then.

“Many states believe they may be pressured to consider previously unthinkable eligibility and benefit reductions,” the Kaiser report concluded. Unless Congress and President Obama extend the federal aid, the cuts needed to balance state budgets may be “on a scale not ever seen in Medicaid,” the authors warned.

“What we will have to look at is wholesale elimination of eligibility groups,” [said a Nevada official.]

From the Omaha World-Herald:

Nebraska’s troubled Beatrice State Developmental Center has moved a step closer to losing $25 million a year in federal Medicaid funds. The state has received word that its appeal of Medicaid decertification has been denied.

The Beatrice Center’s funding has been in jeopardy since September 2006, when it failed seven of eight federal standards and received two federal citations for problems that endangered residents. Earlier this year, state inspectors found that problems at the center had led to the death of an 18-year-old woman.

The center, which cares for about 185 people with intellectual and developmental disabilities, has also been cited by the U.S. Justice Department, which found that its practices had violated residents’ constitutional and legal rights.

Earlier posts here.