Program changes worry CCSS

The hammer finally fell during a phone call. After months of vague warnings that “big changes” might be on the way, Crook County Senior Services (CCSS) Director Jenna Ellsbury heard that the state is making changes to its Wyoming Home Services (WyHS) program that she believes will significantly impact local seniors.

“We have 57 clients in Crook County on this program,” Ellsbury says. “With this program, clients receive emergency alert pendants, homemaking, nursing, personal care, respite and case management.”

It’s the largest grant that CCSS receives, bringing in an annual $71,032.

“It’s a really good grant and it’s our only grant that is 100% state-funded through the aging division. Everything else is subsidized by the federal government,” she explains.

The changes weren’t completely unexpected. In fact, the future of WyHS has been in question since before Ellsbury took over as director.

“Since I started, it’s been an ongoing battle of whether the state is going to keep it, just because it is 100% state funded. It was going back and forth, back and forth,” she says.

It was ultimately approved for two more years, the second of which begins this July. Since that decision, things have been business as usual.

However, says Ellsbury, the changes she had been warned about were finally announced a couple of weeks ago during a phone call open to all Wyoming’s senior service providers. They were brought about by Senate Enrolled Act 12, which was passed during this year’s budget session and calls for the WyHS program to be transformed into a Medicaid 1115 Waiver, a process expected to take between 18 months and three years.

The bill also requires the development of “performance metrics and outcomes measurements” for the program, as well as implementation of a means testing requirement for beneficiaries.

Means testing, says Ellsbury, “Is a method for determining whether someone qualifies for financial assistance to obtain a service or good, for instance, welfare payments. In the past, WyHS qualified clients on physical needs, and the ability to pay for services was placed on a sliding fee scale to address all financial circumstances.” 

During the call, Ellsbury says, she was told that, “We have a soft start date of July 1, so this summer we’re going to start implementing these new requests, but they’re still trying to figure it out.”

Ellsbury has numerous concerns about the Medicaid 1115 Waiver. Her primary concern is the requirement for a lot more documentation than CCSS has asked for in the past.

“No one will want to go through the application process for Medicaid. It is very personal, case workers get involved and it dives into all assets and income,” she says.

“It’s challenging to navigate. Last I heard, it takes three months to complete. It is also intrusive because the public health nurse will have to meet them and evaluate them to qualify.”

She points out that CCSS is very restricted when it comes to case workers.

“It was tough to find caseworkers taking new clients in Crook County throughout the last year,” she says.

“We can’t be the provider and do the casework through Wyoming Medicaid, so that we will need independent caseworkers.”

Meanwhile, she says, Crook County’s limited number of already-busy public health nurses won’t have the time to do LT101 evaluations for CCSS’s 57 clients.

Ellsbury also worries that, “There are no clear rules on asset recovery. No one knows if they will have their assets taken after they pass and, if so, how much. Everyone is afraid that their home or ranch will be taken away.”

In terms of administering the program, she notes that there is “so much more cost” associated with the waiver. Ellsbury heard on the call that the average client costs ten times more than the current WyHS program.

“The average price per person per year on WyHS is about $1,300. The average cost per person per year on a similar program, the Community Choice Wavier program, is approximately $15,000,” she says.

“The average price per person per year on Medicaid in a nursing home is much higher. So yes, the pot of money will be much more significant by plugging into a federal source of funds, but the cost is not worth it.”

Not only will it cost more, she says, it will also create more paperwork – and that’s a problem with a limited workforce available to get it done.

“A lot of our people only need a little help. Many clients only want a medical alert pendant on our WyHS program,” she says. “If we have to do this entire mountain of paperwork and meetings just for a bit of help, our people will go without.”

Medicaid itself is also tough for small centers like Crook County’s to navigate, she adds. CCSS does not have any Medicaid specialists.

“They made a lot of changes to the Medicaid program last summer. I tried calling for assistance. No one answered the phone or called me back for four months,” she says.

“Only after reaching the governor’s office to complain was I able to get a hold of someone. We have very little guidance, no expertise and a lot of requirements.”

Ellsbury’s greatest fear, though, is that small counties like Crook will be forced to drop these services, which can be all that stand between an older person staying in their own home and making the decision to enter long-term care. Crook County simply does not have enough such facilities to cope should that happen, she points out, and both in-home health agencies in this area are not taking on clients at present due to staffing shortages.

“People will die because of this decision,” she says.

Ellsbury also has concerns about the “soft start” approach over the next year. She feels the qualification process for clients is “tricky and invasive” specifically to reduce the number of clients using the program, which will ultimately make the switch to Medicaid easier.

She also feels that it will “greatly increase the administrative cost of the program without any increase of funds to cover the new request” while the invasive process will make it less likely that seniors will request the services they need.

Ellsbury is worried she will lose clients if the documentation requirements are too strict.

“That’s going to put a strain on the EMS system, too,” she says, referring to the emergency medical pendants CCSS offers as an example of the knock-on effects these changes could have.

“The way I see it playing out is that, if people don’t want to provide the information requested, they might say it’s not worth it.”

The pendants CCSS provides include a calling tree that allows a person to call various people for help, including neighbors and family members. While it’s possible to buy a relatively cheap version of these pendants, they will usually only call 911.

CCSS is working on a way to continue providing the pendants, she says, to avoid the alternative scenario in which EMS must respond to medical pendant calls that do not really require emergency intervention.

It may not be too late, Ellsbury says. She intends to testify before legislators on June 2 and 3 to explain the many issues these changes will cause for local services.

“CCSS will be monitoring the situation very closely.  We want to continue to provide current services in the least restrictive means,” she says. 

“CCSS will be seeking alternative funding to help navigate these changes to serve our clients better. The Crook County Senior Citizen Services District provides financial assistance to help CCSS navigate these changes. We do not want to see anyone who needs assistance go without, and we will try our best to service every need.”