To: Michael Willden, (Director of Nevada Health And Human Services) Sunday, January 16, 2011                 

It Is Time to Change Nevada Medicaid.

Dear Mr. Willden,

How can we lessen the budget pressure and set a better course for Nevada Medicaid?  You can implement cost-effective remedies previously presented to you and to Gov. Gibbons.  As they greatly impact Nevada's elderly and folks with disabilities, please get going on these things:

 1. Create a "Go Home Authorization/voucher", (offering recipients 90% of the state's expenses for their institutional care, to use for their choice of homecare).  Combine this into the "Money Follows the Person" plan/application.  It should broadly grant all unwillingly institutionalized people free choice of homecare, insofar as it complies with federal guidelines and is cost-effective for our state.

2. Fairly allow equal access to the "Independent Caregiver Option" for all homecare recipients who want the more cost-effective option.  (Equally allowing this better paying, self-directed care, at an 8% lower caregiver cost and up to an 80% reduced nursing cost… This should be a no-brainer.)

3. Apply "Wage Proportionate Disbursements" to homecare provider agencies, in order to reduce homecare costs in a way that protects caregivers and recipients.

You can implement all three in a way that guarantees a reduction in the State's Medicaid home care cost while strengthening very important quality of life aspects for vulnerable people.   (Take to heart the well-being of those who can't speak for themselves and act in their behalf.)

Further Reasons…
I know you understand eliminating homecare services, which some refer to as "optional", is baloney.  It would fly in the face of the Supreme Court's Olmstead ruling that prohibits ongoing unnecessary institutionalization.  (Skirting that decision and neglecting the people who would be harmed, should not even be mentioned as optional.) 

It is equally foolish to continue spending on those who are already, unwillingly institutionalized… especially when a far superior at-home-care, can typically be provided for less money.  You should rather be cutting back the millions you currently allocate to nursing facilities for this *unwanted institutionalization.

Shifting monies, now paid for imposed institutional care, over to providing less costly home care services, is a way of helping our elderly, saving money and, complying with the Supreme Court's ruling. The Feds offer** our state a 2% reduction in these Medicaid costs if your department will reduce its institutional bias, (to at least 50% home care and 50% institutionalization of people). **ACA of 2010, Section 10202

Additionally, the Feds will pick up approximately 75% of the first year's costs for any person who is set free by a successful "Money Follows the Person" program.  This closely parallels what we have been telling you for years… Create a reasonable "Go Home Authorization" for people who are unwillingly institutionalized. 

These changes offend some big-money, healthcare interests.
It's time to set aside the preferences of these good-old-boys. The community's interest must be put above the profits of nursing facilities and corporate homecare agencies.  

Nevada's Medicaid tends to streamline its administrative duties and fights against difficult change.
Will the department continue to craft excuses to dismiss unwelcome change, or will it work on making the innovations work?  It's time to implement solutions… not based on satisfying corporate interests or administrative preferences.  These difficult changes will save money and deliver a better quality of life for many Nevadans. 

It's time to do what's right…

• Prove the feasibility. Determine the ongoing institutional care expenditures for the Nevadans who would take a less expensive home care option.  Be driven by the human dignity and the fairness that acting in their behalf will bring.
• Give full disclosure of the related information and openly communicate with those of us who are directly affected. Similarly, set up open access with a federal CMS representative.
• Redirect Mr. Duarte to make these policy changes that are budget reducing and will help Nevada's most vulnerable people.  Bringing relief and comfort to our people who are elderly and disabled… This is the honorable course to take.

Sincerely,  
Rick Cline, (a People First person)
Tiffany Hunter, (a People First person)
Mary Bryant, (a Parent Advocate)
Katherine Burcham, (KB)
Randall Johnson, (an Independent Caregiver)
Carol Hunter,  (an Independent Caregiver)

*Latest CMS statistics for Nevada indicate that there are approximately 1500 people who have formally indicated, (in question Q1a), they don't want to continue living in institutional facilities.

cc: Gov. Jim Gibbons, Gov. Brian Sandoval, Stakeholders and others who are concerned about the well-being of Nevada's more vulnerable people.