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Malloy Proposes Cutting Medicaid Program That Many See As Cost Effective

A Medicaid program designed to help keep intellectually or physically disabled patients out of nursing homes and institutions is on the chopping block in Gov. Dannel P. Malloy's budget proposal — a move that advocates and family members said they find baffling.

"It keeps people where they want to be the most — at home, and it saves everyone money," Erin Mahoney, 37, of Bristol, said of Community First Choice program, where Medicaid patients hire their own in-home aides at a lower rate than governments pay agencies for the same services.

Mahoney's mother, who has early-onset Alzheimer's, was just approved this week to have personal-care attendants come to her home to assist Mahoney and her father in tending to her mother.

Otherwise, in time, "she would absolutely be in a nursing home at triple the cost," Mahoney said.

Malloy proposed cutting all of the state's $3.8 million annual share of Community First Choice, which became an option for states under the Affordable Care Act. While all of these programs are threatened nationally, there has been bipartisan support locally for Community First Choice. It is intended to keep people out of costlier levels of care, and gives states 56 cents back on every dollar spent, six points higher than the 50 percent reimbursement rate of other Medicaid programs.

State officials said that if Community First Choice is cut, they are making provisions to allow Medicaid patients who have hired the in-home aides to retain them even as they shift back to other Medicaid coverage, thus softening the blow.

There are 1,000 people receiving services through Community First Choice, and another 3,000 are waiting to get into the program.

"If you think through the logic, the governor's cut doesn't square," said Claudio Gualtieri, associate state director of AARP Connecticut and chairperson of a statewide council on Community First Choice.

"You know, it's a well-designed program that is tailored to the people who qualify to be in it, and the dollars go a lot further. You can keep three seniors at home for the cost of one in a nursing home. This is why I say the [proposed cut] is short-sighted. They are not thinking through the consequences here," said Gualtieri.

State officials counter by saying that Community First Choice has drawn far more applicants than was envisioned. The state's share would continue to rise each year, particularly if the additional reimbursement of 6 percent is eliminated by Congress, the officials said. Many states anticipate such changes in federal funding.

"Enrollment in CFC has been significantly higher than expected – and it has become unsustainable in the current fiscal situation," said David Dearborn, spokesman for the Department of Social Services, "The caseload growth can't be supported."

Thomas Fiorentino, a retired assistant state attorney general whose son has an intellectual disability, said it is a travesty that the state would continue to spend millions of dollars in overtime each year at state institutions, but the governor has proposed taking "a hatchet to a very Spartan-like, low-cost program like CFC, which is run by the families that use it."

The cut, said Fiorentino, who is president of the board at The Arc Connecticut, "is indefensible." 

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