Connecticut’s Public Act 09-5 Section 66

I am outraged that as of January 1, 2010 some of my elderly patients here in Connecticut will be forced to pay a 15% copay for services they receive in their homes. These are my non-Medicaid patients who are on the Connecticut Homecare Program for the Elderly. This program provides services such as home health aides, homemakers, and nurses to the elderly who meet the financial requirements of the program. Apparently, the legislature wanted to put a financial cap on the monies spent for individual services but decided instead to go for a cost-sharing program.

 Public Act 09-5 Section 66 is the statute that mandates the 15% copay. Here is how it works:

 The client has 30 days from the date of the bill to remit a payment. If the next month’s bill is ready to go out and no payment has been received on the previous bill, the client will get a notice informing them that the bill is past due and must be paid within 10 days or services will be discontinued. If there is no payment made in the 10 day period, the Alternate Care will issue a discontinuance notice and give the client an additional 10 days to remit payment. If the client pays the past due amount, they can stay on the program unless they fall behind by more than one month. Clients who go off the program for non-compliance with the cost sharing requirements may reapply for the program but services may not be initiated until they remit the full amount past due. Per the statute, clients are not entitled to a Fair Hearing for a discontinuance related to non-compliance with the cost sharing requirements. The statute does not allow for any hardship exceptions under the cost sharing requirement.

 So it seems that the senior pays the copay or they are out of the program with no appeal rights or hardship exceptions. Outrageous!

 Let me tell you about Bill (the name and some of the facts have been changed to protect his identity).

Bill lives alone in a low-income housing project in a neighboring town. I started to see him about two years ago when his diabetes was out of control and he needed to start insulin. While he learned how to give himself shots, he could not remember to do it on a daily basis. By taking his insulin eradically, his blood sugars were all over the place. One time he even took two doses of insulin in one day. Thankfully he survived without harm. It was evident that he had significant short-term memory problems that made living alone a challenge.

 Bill’s wife died years ago and there were no children. He only has one living relative, a brother who is in a nursing home in Florida with advanced Parkinson’s disease. Bill is all alone except for his nurse, his home health aid, and his homemaker paid for by the Connecticut Homecare Program for the elderly.

 We have worked hard to give Bill the support he needs so he can remain safely in his own home. In the beginning, his personal hygiene was compromised by his memory problems. A health aide now bathes him. A homemaker launders his clothes and keeps his home clean. He couldn’t remember to take his pills so we got him a locked medication box that alarms when it is time to take his pills. We have set up a plan to provide someone to remind him every day to take his insulin that I draw up ahead of time. We even have the weekend nurse call him to remind him to take his insulin and stay on the phone until he takes it. He has not required hospitalization once since we have been seeing him. He is safe. His needs are being met and he gets to stay in his home.

 The monthly copay that he will be expected to pay as of January 1 is about $243 a month. I’m doubtful that he will be able to pay it. What will happen then? He can’t remember to take insulin or his pill on his own without our help. I can only imagine that he will end up dead from too much or too little insulin or require frequent hospitalizations to keep him stabilized. Ultimately he may need to go on Medicaid so he can be placed in a long-term facility. That seems to be more costly to the state then paying for the kind of services he is getting in his home now.

 Bill is just one of the many effected by this statute. As a registered nurse, I am real worried. Worried about Bill. Worried about all the elderly on this program who may think they will be safe if they choose to reduce their services because they want to save money. We know they run a great risk when they do that. Maybe the copay will work for more people than we know but there will definitely be hardship cases. They need to be heard.

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