BEHIND THE HEADLINES Access to Jewish nursing homes threatened by managed heath care

WASHINGTON, July 22 (JTA) — You can no longer care for your 89-year-old mother — so the family agrees that the local Jewish nursing home is the best place for her. The traumatic adjustment will be eased, you hope, because of the home’s Jewish environment. Families make this difficult choice all the time, sending their loved ones to one of 250 Jewish nursing homes across the country. But this time the director of the home tells you that Medicaid will not cover the cost of the home because, you might be told, the facility is not “in the network.” Just a few years ago, such a scenario was unimaginable. As long as a senior qualified on the basis of financial need, Medicaid – – the federal-state program that helps pay for health care for the needy, young and old, and some disabled — paid its share for care in virtually any home. But revolutionary changes in the way the federal government provides health care coverage to America’s seniors have led to limited access to all nursing homes, including religiously affiliated facilities. “We’re talking about thousands of frail, elderly Jewish people who will find themselves in an intolerable and tragic situation,” said Lawrence Zippin, executive vice president of the North American Association of Jewish Homes and Housing for the Aging. “This would be philosophically, theologically and financially cataclysmic if they wind up in a non-Jewish home.” The changes for seniors promise to be even more dramatic as Congress pursues the overhaul of Medicaid and Medicare — the federal health care insurance program available to those over 65 years old — in its effort to balance the budget. Already, as America shifts to managed care — where patients must seek services from an approved list of providers — seniors who rely on Medicaid to pay for nursing home care are being asked to choose a facility in a government-approved network. Virtually all residents in Jewish nursing homes rely on Medicaid for the cost of their care. In a little-known provision in the balanced budget bill adopted by the Senate earlier this month, Congress has begun to address the concern over access to sectarian nursing homes. Under the measure, nursing homes outside the network would have to accept the same Medicaid payment that in-network homes receive. But the ability to choose a religious-based nursing home is only one of many threats facing elderly Americans — both Jews and non-Jews — and the facilities that provide them with care. Elderly advocates and lawmakers agree that in the coming months, the relationship among elderly Americans, the federal government and service providers will change. What they don’t know is exactly how. Congress is preparing to send President Clinton a balanced budget bill that includes $115 billion savings in Medicare reforms and more than $16 billion in Medicaid reforms. Among the measures being debated: * increasing the Medicare eligibility age from 65 to 67; * charging a $5 co-payment for home health care; * charging a higher premium for wealthier Medicare recipients; and * repealing guarantees that the government will pay reasonable and adequate reimbursements. For the Jewish community, how Congress reforms Medicaid and Medicare will directly affect the future of hundreds of nursing homes, hospitals and Jewish social service agencies. All of these institutions rely heavily on federal funds. In fact, an unscientific survey last year by the Council of Jewish Federations found that more than $3 billion flows annually into the Jewish community from Medicare. Hundreds of millions more in federal dollars come from
Medicaid. A large part of the proposed savings would come from shifting Medicare and Medicaid recipients into managed care networks. Two of every 10 Medicaid recipients will be in a managed care program by the end of the year, according to congressional budget staffers. The number could double next year as New York and California finalize plans to shift their poor populations into networks. Although there are no reported examples that a Jewish applicant has yet to be denied access to a Jewish nursing home because of the managed care restriction, experts in the field say it is only a matter of time before problems arise. In addition to the trauma the elderly would face, activists fear that the nursing homes themselves could lose their distinct Jewish character. Without Jewish applicants, many homes would be forced to create a more secular atmosphere to attract new clients. Indeed, managed care could regulate them out of business. It is not clear how many Jewish nursing homes currently are part of managed care networks. But even if they all were to become part of a network, there would be no guarantee that a particular home would be part of the network a senior belonged to. Although the legislative measure continues to garner support — especially because it requires no additional federal money — it still must be incorporated into the final version of the balanced budget bill and clear several legislative hurdles before it becomes law. With so much at stake in the battles over Medicare and Medicaid reform, the issue has catapulted to the top of the Jewish communal agenda — right up there with welfare reform and the impending cutoff of federal benefits for legal immigrants. Responding to the urgency, the CJF Washington Action Office assigned a senior staffer to study how the proposed changes would affect the Jewish community. Jewish community officials are particularly concerned that shifting the cost of care from the government to individuals could prove a strain for Jewish institutions. “We are talking about people on fixed incomes who would turn to our institutions for assistance,” said Diana Aviv, director of CJF’s Washington office. With the proposed reforms expected to touch virtually all Americans in one way or another, Jewish officials hope that more people will begin to focus on the issue. “The group of people going to be dramatically affected by all of this have not been heard from — the baby boomers,” said Zippin of the Jewish Homes association. “They will face questions like: `Do I help pay for mom’s care or put money away for junior’s college?’ These are universal issues, and these are complex.”