Why must Virginia's elderly be in nursing homes to get Medicaid support?

Date published: 4/3/2008

LARRY HAUBNER is a poster boy of sorts. The 105-year-old resident of Greenfield at Fredericksburg, an assisted-living facility, became the subject of news stories in The Free Lance-Star last year that were picked up by national and foreign media. Mr. Haubner, healthy and happy at Greenfield, was outliving his savings. It looked as if he might be unable to stay in his beloved home. His story highlights a gaping hole in Virginia's care for elderly residents: the failure of the state to ask for Medicaid waivers for people in assisted-living settings.

Piecing together the quilt of care the aged need is a daunting task for novices. Let's start with the basics. Just what is a Medicaid waiver? And why would a healthy centenarian be forced into a nursing home because he didn't have one?

Medicaid is the joint federal-state program created in 1965 to help low-income people get necessary medical help. Each state manages its own Medicaid program and establishes its own criteria for eligibility--along with the level of funding it wants to provide. When Medicaid began, assisted-living facilities did not exist, so the program covers only nursing-home care for elderly recipients.

But a rising number of older people need just a little help--the kind offered by assisted-living centers--to get by. To include such people in the Medicaid program, states must ask Washington to waive the requirement that a nursing home provide the person's care. Forty-one states have indeed sought that waiver--but not Virginia.

Thus, as Mr. Haubner's savings ebbed, it looked as if he would need to be moved to a nursing home so he could qualify for Medicaid. Instead, his plight came to the notice of the public, which contributed some $60,000 to supplement his income--enough to keep him at Greenfield a couple of more years.

The issue, of course, is funding. Asking the feds for Medicaid waivers for residents in assisted-living facilities would oblige the state to pay for another new category of people. What's been the relevant history so far?

In 1985, Virginia spent 7.7 percent of the state budget on Medicaid. By 2006, that figure had skyrocketed to 19 percent. The commonwealth ranks 22nd among the states in Medicaid spending, though it is 12th in population. The chance of extra Medicaid funding in these tight times? No chance.

Mr. Haubner's story had a happy ending, thanks to the generosity of the community and a few caring individuals. More people like him can be helped if Virginia seeks Medicaid waivers. (The governor's task force on health reform agrees.) For now, we await a sunny day, a window of opportunity, and a renewed will to help the frail elderly.

Date published: 4/3/2008

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