Leavitt calls homecare

WASHINGTON -- Michael Leavitt, secretary of the Department of Health and Human Services, in April called for more home and community based care in Medicaid. In a speech here at the National Conference of State Legislatures, Leavitt said, "We need to change the basic construct of Medicaid to allow for home and community care to be used. It's not only where people want to be served, but it's radically more efficient. And it doesn't mean that we are not going to be spending money on healthcare but it means we are going to be in a place where we can in fact serve more people." Leavitt's recent comments come as providers in many states are trying to stave off cuts that threaten to dismantle home health care and DME benefits. They also reiterate a philosophical stance that he declared in a Feb. 1 speech to the World Health Care Congress. In that speech, Leavitt contrasted neighboring states of similar size, Vermont and New Hampshire. In Vermont, he said, 85% of Medicaid's senior (over 65) population lives at home thanks to a highly developed home and community based healthcare system. Next door in New Hampshire, only half of Medicaid's seniors live at home. Consequently, Vermont pays less than half what New Hampshire pays to care for elderly people on Medicaid. "Providing the care that lets people live at home if they want is less expensive than providing nursing home care," Leavitt said. Invacare was so taken by Leavitt's February remarks they plastered them on the back cover of their annual report. While the industry welcomes Leavitt's remarks, they're still waiting for the other shoe to drop -- for the philosophy to hit the street and reroute some of the catastrophic situations in various states. But things may get worse before they get better. "We're running on two parallel tracks," said Cara Bachenheimer, Invacare's vice president of government relations. "The Administration is proposing massive changes to Medicaid from the federal law perspective, meanwhile each state is puttering along, and required to balance their budgets. Once we have a convergence of the two, it's going to be even worse." Many states, like Vermont, currently have waivers from the DHHS, which allows them to put individuals in charge of money that enables more home care.