Missouri Home Health Cuts Fall Short of Expectations

In 2017, Missouri lawmakers voted to change how home health funding was distributed by effectively raising the bar on a needs-based patient scoring system. The change, lawmakers had hoped, would cut state spending on home-based services and save tens of millions of dollars in the process.

But a recent state audit suggests those savings have fallen far short of expectations.

In general, home health care and other home-based services have been shown to lower health care spending by keeping patients at home — the lowest care setting — and out of hospitals or skilled nursing facilities (SNFs). In Missouri, funding for home-based care services is divvied out to patients on a needs-based scoring system used by the Department of Health and Senior Services, which quantifies the level and intensity of care.

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Prior to 2017, for example, patients with a score above 21 were eligible for state-funded home-based care services, St. Louis Public Radio reported. After the controversial change — supported by Gov. Eric Greitens — that score shot up to 24.

Changes also included caps on how many units of service individuals could receive, according to St. Louis Public Radio.

In total, the changes were supposed to save $43 million. In reality, they led to savings of just one-fourth that amount, the state audit found.

The reason why: expectations did not take into account the overall rising cost of health care, nor the fact that patients get sicker over time and as they age. That’s a major oversight, critics say, especially in a rapidly aging and chronically ill Missouri.

In 2017, more than 16% of Missouri’s 6.11 million residents were over the age of 65, according to Missouri Census Data Center statistics. About 26% of the population was between 45 to 64.

Nationally, about six in every 10 adults in the U.S. are living with some form of chronic disease, according to the Centers for Disease Control and Prevention (CDC). About four in every 10 adults are living with two or more chronic conditions — ailments that include heart disease, chronic lung disease, diabetes and Alzheimer’s.

Up to 71% of deaths in Missouri can be linked to chronic diseases, past research has found.

“It seems like it’s something they could have had a handle on, in my opinion; All this historical data related to level of care scores shows they do increase,” Kim Lackey, policy director at the disability-rights advocacy organization Paraquad, told St. Louis Public Radio. “More realistic estimates would have helped avoid these problems.”

In addition to failing to account for a sicker and older population, lawmakers’ savings projections also likely fell short because Missouri is now spending more per person for services due to the rising reimbursement for home-based care providers.

Missouri’s push to curb home health spending comes as federal policymakers actually give home health providers a bump. CMS projects that Medicare payments to home health agencies in calendar year 2019 will be increased by 2.2% — or $420 million — based on its final payment rule announced in October.

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