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Medicaid cut could scale back nurses’ visits to patients’ homes

Said Tarl Grenier (above) of services offered to this father, who died last month: “Without the nurses coming and helping, I would have had to put him in a nursing home — which was his worst nightmare.”Mary Schwalm for The Boston Globe

The Baker administration wants to cut how much the state pays for long-term home nursing care, a move to contain medical spending. But that may leave thousands of patients without the services they need, home health agencies warn.

Leaders of several agencies said the proposed 25 percent rate cut would make it unaffordable for them to continue sending nurses to the homes of people with complex, chronic conditions like diabetes, heart disease, and schizophrenia. Patients may lose access to nursing services at home, and they could end up in nursing homes, the agencies said.

Governor Charlie Baker’s team is seeking to rein in the taxpayer-funded Medicaid program, or MassHealth, which serves 1.9 million people with little or no income. Officials have singled out MassHealth’s spending on home health, which includes nursing, physical therapy, and other services, as an area that especially needs trimming. MassHealth’s outlays are expected to rise 5 percent in the next fiscal year, to $16.2 billion, accounting for about 40 percent of the state budget.

Home health companies, which contract with the state to provide services to MassHealth members, have generally been receptive to the cost-saving measures, including stricter approval requirements for patient services. But the latest proposal goes too far, they say.


The rate cut would apply to about 7,000 people who have been receiving nursing care at home for more than six months, according to state officials. Some have been getting services for several years. Officials have not made a final decision on the payment rates, which are set to kick in July 1. They said they will consider public input before acting.

“I just don’t know how we do this,” said RJ Lawson, nursing supervisor at Boston Home Health Aides, an agency in Lawrence. “A lot of agencies are struggling to survive at the current rate. A 25 percent rate cut — I think ultimately it will force us to stop seeing some patients.”


Joseph P. McDonough, president of Somerville-based Nizhoni Health, was even more blunt. “Thousands of patients will be discharged from home health services due to the inability of agencies to cover the costs of providing care,” he told state officials at public hearing in January. “This rate cut will likely have a devastating, negative impact on patients’ ability to access care in the community.”

MassHealth is planning to pay slightly more for nursing visits to patients receiving services for 30 days or less, at a rate of $89.21 per visit. The controversy is over the proposed rate for patients who need nursing after 180 days. The state currently pays $69.59 for those visits, but it plans to slash that to $52.19.

The new rate “aligns payment with patient acuity,” MassHealth spokeswoman Sharon Torgerson said, and would help save about $13.7 million a year.

Those savings account for less than 2 percent of all home health spending, estimated at $780 million this fiscal year.

“Our goal is to ensure funds are properly allocated, based on the level of care an individual needs, and that the proposed regulations will not result in benefits cut for anyone,” Torgerson said in an e-mail.

Brandon Howes, president of Comfort Home Care in Methuen, said cutting rates for longtime patients implies that their care becomes easier over time. But that’s not true, he said: “They’re chronic. That’s why we have them that long.”


Most of Comfort Home Care’s patients have some form of mental illness, such as schizophrenia or bipolar disorder, he said. Many need to see a nurse daily or weekly to receive medications. For patients with physical illnesses like heart disease and hypertension, nurses also have to check vital signs regularly.

Home health services must be ordered by doctors and approved by MassHealth officials.

“We can’t continue to care for those patients” at the lower rates, Howes said. “So the burden, if we can’t care for them, is going to be shifted to hospitals, long-term care facilities, community agencies, possibly jail and police departments.”

Tarl Grenier’s father is among the patients whose health problems were so severe that nurses checked on him twice a day. He had diabetes and paranoid schizophrenia. He was overweight and needed an oxygen tank to help him breathe. Carl Freeman Grenier, 61, died last month at home in Lowell.

“Without the nurses coming and helping, I would have had to put him in a nursing home — which was his worst nightmare,” said his son.

Grenier worries about what would happen to patients like his father if state officials cut home nursing rates. “If they have a smaller budget to work with, they have to do everything a heck of a lot faster than they do now,” he said. “The quality of care they’d be able to provide would go down.”

But while many home health agencies provide crucial services to patients in need, administration officials believe others may be taking advantage of the system. Spending on home health services surged 30 percent in the fiscal year ended June 30, to $750 million, state officials said.


To tackle wasteful spending, they stopped doing business with new home health companies, strengthened prior authorization requirements, and audited several agencies. They also asked the attorney general to investigate several home health companies’ billing practices and stopped paying two companies accused of fraud.

As a result, administration officials said, home health spending is projected to grow a more modest 4 percent in the current fiscal year, and 8 percent in the year that begins July 1.

The Home Care Alliance of Massachusetts, a trade group, credited the administration for taking steps to control spending, but it is fighting the latest proposal to slash rates.

“There’s been too much change too fast,” said Pat Kelleher, executive director of the alliance. “This might create a sense of agencies having to make a financial decision rather than a clinical decision.”

Priyanka Dayal McCluskey can be reached at priyanka.mccluskey@globe.com. Follow her on Twitter @priyanka_dayal.