Inside Augusta

Emergency bill brings common sense reform to in-home care services

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One of the few bills making it through Legislative Council this session that actually rises to the emergency threshold outlined in the Maine Constitution is LD 1708, “An Act to Allow Qualifying Medicaid Recipients to Hire Relatives and Legal Guardians for Consumer-directed Attendant Services.” The bill, sponsored by Rep. Patrick Corey, R-Windham, would allow qualifying medicaid recipients to hire spouses and legal guardians as their personal care attendant for in-home care services.

Mainers who currently utilize the state’s consumer-directed attendant services have the flexibility to hire some family members as their in-home caregiver. However, federal rules prevent a Medicaid recipient’s legally liable relatives, like a spouse, from delivering and receiving payment for services as a personal care attendant. This is what LD 1708 seeks to overturn, because for the many Mainers who utilize these services, their spouse is their natural caregiver; and therefore the natural choice to provide these services.

Despite their inability to be officially hired as caregivers, spouses of in-home care recipients still spend a significant amount of time and resources caring for their loved ones. Some spouses are forced to quit their jobs to provide care around the clock, and do so without receiving payment. In addition, their workload around the home doubles when their husband or wife becomes physically unable to contribute.

This is incredibly taxing for Maine families and puts them under great economic, physical, and emotional stress. Further, the backwards system in place today actually advocates for couples to get divorced, as this is the only way a spouse could receive payment for the care they provide.

There is minimal fiscal impact to enact this change, and its passage could actually reduce future expenditures by DHHS. These programs, like Participant Directed Option (PDO) and other self-directed home care programs, provide care for Mainers in their own homes and communities. This prevents vulnerable Mainers from needing services at long-term care facilities, which are far more costly to state taxpayers than allowing the spouse of a PDO consumer to be paid for the care they regularly provide to their loved one.

With labor shortages across Maine within the in-home care industry, passage of LD 1708 would mitigate Maine’s recruiting troubles by giving patients immediate access to the care and services they desperately need. It would also ease the financial burden on Maine families who struggle to direct care.

Opponents claim the passage of a bill like LD 1708 would make the system ripe for abuse, however there is little evidence of such fraud in other states where similar measures have been enacted. As of May 2017, at least 12 states have submitted waivers to the federal government to allow spouses to receive payment for providing primary care attendant services under a state Medicaid program. Additionally, the consumer of in-home care services will always have to option to seek services elsewhere if the care provided by a spouse or relative does not meet their needs; hence the name “consumer-directed attendant services.”

A 2011 study funded by the federal Department of Health and Human Services concludes there is “no financial disadvantage to Medicaid and some quality and cost advantages (particularly the much lower rate of preventable hospital stays among elderly in-home supportive service recipients) from allowing spouses to be paid providers.” In addition, the report advocates for “honoring recipient and family preferences for paid spouse providers.”

LD 1708 is a common sense reform that many other states have already considered and passed. Maine should follow suit to provide to our most vulnerable citizens the quality care they need and deserve.

About Jacob Posik

Jacob Posik, of Turner, is a policy analyst for the Maine Heritage Policy Center. He can be reached at jposik@mainepolicy.org.

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