Last year the state Legislature slashed $50 million from a program that provides in-home care to disabled Missourians. Even though some money was eventually restored, some advocates say those cuts have created a dire situation and could force some people into nursing homes.
For some disabled Missourians, the cuts mean fewer hours with the personal attendants who assist them with daily tasks they cannot perform.
Less help poses problems for Steve Foelsch, 53, of St. Louis, a quadriplegic who is paralyzed from the chest down.
He relies on his attendants for the most basic of needs: They get him out of bed each morning and put him in bed at night, prepare meals for him and bathe him.
The cuts have forced him to nearly max out his credit card so he could pay for attendants to stay longer, time the state will no longer pay for.
“When you make a cut like this, I’m just dangerously close to going into a nursing home,” Foelsch said.
Sending him to a nursing home would end up costing taxpayers more money and would force him to leave his job, he said. He teaches at Maryville University and also works as director of education and training at Starkloff Disability Institute. Because he’s working, he pays taxes and a premium to Medicaid, the state-run insurance program that he benefits from, he said.
“All of my money is spent in a four- or five-block area. All the money that I have gets pumped right back into the St. Louis economy,” he said. “You put me in a nursing home and you’re (the state) paying some national conglomerate money, and that may be going to New Jersey or Nevada.”
In May, Foelsch was able to qualify for another program that assists with the cost of his attendants. But the program has limited spots and he has to be reassessed each year to qualify. He fears he could be right back where he was earlier this year. And he worries about disabled Missourians with no options.
Suzan Weller of Disability Resource Association said her organization scrambled to find options for its clients such as Foelsch.
“At this point, there are several thousand individuals in the state that are needing more care but are having a difficult time due to those cuts,” Weller said. “If you can’t live on your own with the limited hours, what other options do you have?”
The cuts will force some into nursing homes, Weller said.
“What it comes down to is dignity and respect of a human life,” Weller said.
The affected program, known as consumer-directed services, allows disabled Missourians to hire the attendants they want in their homes to help them with daily tasks and personal care. The attendants do not have to be licensed medical professionals.
Disabled Missourians are evaluated and must qualify for services based on the score that they receive. Last year, the state raised the threshold.
It’s a subjective evaluation, and many who once met the threshold have seen their scores raised, according to state Rep. Deb Lavender, D-Kirkwood, who is also a physical therapist.
Money to pay for the attendants comes from Medicaid, the state-run insurance program for the poor. And that spending was outpacing state revenue, state Rep. Scott Fitzpatrick, R-Shell Knob, told the Post-Dispatch. He also serves as chairman of the House Budget Committee.
“We were cutting things drastically everywhere else before we came to these services,” Fitzpatrick said, citing higher education costs as an example.
Last year, lawmakers decided to cap the amount spent on the consumer-directed services. The cap resulted in $36 million in cuts: $13 million in state spending and $23 million in matching funds from the federal government.
The cuts affected at least 7,844 disabled Missourians, according to figures from Fitzpatrick.
The state also cut rates to providers by 3 percent. That saved $14 million: $5 million from state funds and $9 million in federal funds.
Ultimately, of the $50 million that was cut, $8 million was restored for fiscal year 2019, according to figures from Fitzpatrick’s office.
Advocates say less care can lead to an increased risk of hospitalization and ultimately higher costs.
“Just one hospitalization due to lack of care cancels out any savings,” officials with Paraquad, a St. Louis-based nonprofit organization that helps people with disabilities remain independent, said in literature about the cuts.
One hospital stay for a Medicaid patient is about $9,000, according to Paraquad. The cuts resulted in an estimated savings of $5,321 per participant per year, according to Paraquad.
“It’s bad. I’ve been at Paraquad for 11 years and I haven’t seen a cut like this before,” said Kimberley Lackey, director of public policy and advocacy for the nonprofit.
Lavender said she worried about the long-term effects of cutting hours.
“How many people losing two hours of services a day, how many were left in positions in ways that created so many other problems,” such as pressure sores, Lavender said.