Should states be able to require people whose elderly parents receive government-paid nursing home care to take on at least part of this financial burden? I believe they should.
In the past, federal policy has totally precluded states from requiring any financial contribution from the children of Medicaid recipients of long- term care services, regardless of how wealthy those children may be.
We believe states should be allowed to require children to contribute to the cost of their parents' nursing home care. In many instances, such requirements may be far fairer and more humane than the alternatives.
Extraordinary fiscal pressures are forcing states to reduce critical services for persons in great need of assistance. Virtually every state is faced with serious economic problems.
The Medicaid program, which constitutes the most problematic and rapidly rising component of most state budgets, has seriously exacerbated the state budget problem. While state revenues and reserves combined will have increased by only about 17 percent from fiscal year 1980 to 1983, the state share of Medicaid costs will have grown by 44 percent. These Medicaid cost increases, which in part reflect a shift of federal Medicaid costs to states, have forced a number of states to impose severe cuts in critical activities ranging from protective services for abused children to public protection and education.
Further, the growth in Medicaid costs would have been far greater were it not for unprecedented state cuts in Medicaid services, eligibility standards and reimbursement levels. In 1978, 1979 and 1980, the number of Medicaid program expansions was about equal to the number of cutbacks. In 1981 and early 1982, states adopted five times as many reductions as expansions.
This is clear and dramatic evidence that states are, in fact, being forced to impose significant cutbacks in a program that serves many individuals in desperate need of assistance.
Contrary to public opinion, a significant number of Medicaid's most costly recipients--nursing home residents-- do not come from the chronically poor population normally associated with the program. Some--and no one knows precisely how many--come from families with very substantial resources.
Does it make sense to require states to provide huge financial subsidies to some families that are very well off while fiscal conditions are forcing cuts in needed services for destitute individuals with no alternative resources?
It is estimated that for every nursing home resident, there are two people who are sick and disabled enough to qualify for nursing home care but who are cared for by family or friends. Public policy should encourage rather than discourage such family support.
Federal policies have created a huge economic incentive for sons and daughters to rely on the state for room, board and support services for their functionally impaired parents. Is it equitable to require large financial subsidies to some families that are very well off, while other families with far fewer resources shoulder the responsibility for their parents and pay taxes that support such subsidies? At what point do such public policies cause, rather than merely reflect, a deterioration in the sense of personal responsibility?
Because of the difficult and complex nature of the issues involved, states should have the authority to adopt requirements that make sense in the state's actual policy context and which are sensitive to individual circumstances.
For example, a bill under consideration in the Wisconsin legislature last year, which is expected to be introduced again shortly, would require families with net taxable income of more than $115,000 to pay the full cost of nursing home care. A progressive sliding scale would establish a floor of $30,000 net taxable income for which the family contribution would be $3.25 per day. Family members with income less than $30,000 would not be affected. Further, liability would be waived where severe hardships or injustice would be caused.
Given the difficult choices facing states in ensuring services for the nation's neediest individuals, we should not be precluded from adopting sensible and humane alternative policies similar to the Wisconsin proposal. It is unfair and unwise to cut back federal funds available for state-administered programs and not give the states the flexibility to adopt remedies that we believe are most sensible.