Bill could put private case managers out of business

A proposed House bill would study the merits of asking counties to provide case management for disabled and elderly Medicaid clients living at home – a change that might put four large case-management firms out of business and shake up much of the human services bureaucracy by letting new people make the referrals for care.

As sponsor of House Bill 1208, Rep. Bernie Buzzell, D-Berlin, testified last Thursday that counties could handle the task better than private case management agencies currently doing the job under state contracts. Their field workers have to keep close tabs on vulnerable people living outside of nursing homes and help them cope with landlords, pharmacies, clinicians and red tape. These gatekeepers also choose service providers and care settings for their clients.

Buzzell, a former case manager, denied claims his bill would impose an unfunded mandate on local taxpayers because the Medicaid money for case managers would go to the counties. He said the total budget for private case management for the elderly alone has grown 200 percent since the state delegated this function four years ago.

“Nobody did any cost-benefit analysis when (former Health and Human Services Commissioner) Donald Shumway privatized case management,” Buzzell said. “Some of the independent case management agencies are reporting clients for self-neglect. It lets them dip into another pool of money. Clients can end up with several case managers. That’s an inefficient use of state dollars.”

Rep. Tom Donovan, D-Claremont, works for Heritage Case Management and said Medicaid pays $8 per day per client. As he explained, the budget for case management has grown because the caseload has increased. “The overall cost per client has gone down,” he said.

Independent case managers have tracked their quarterly costs for several years. Their latest report shows the average treatment cost for a person living at home with their help has dropped in recent years from $290 a week to $257. Meanwhile, average nursing home costs have climbed from about $800 per week to about $1,200.

Greg Moore, a spokesman for Health and Human Services, told a House committee the new GraniteCare law already lets the counties take over case management for the elderly if they wish, making part of HB 1208 unneeded. He also noted counties have no fiscal incentive to handle case management for the developmentally disabled or the head injured because none of the related Medicaid funding comes from the counties. It would save them nothing if they could do the job well.

Buzzell criticized the state last month for neglecting this same at-risk population. He gave the governor and key lawmakers his finding that state abuse investigators seldom alert police of cases as required. Buzzell polled police departments in Coos County and learned they had been notified in only eight of 93 substantiated cases in the last five years. – CHRIS DORNIN/GOLDEN DOME NEWS SERVICE