The Political and Real Cost Of At-Home Disability Care

Nov 13, 2014

State legislators on Thursday considered the future of a healthcare policy that would allow funding for the disabled to be used for home-based and community care instead of only institutional settings. The Community First Choice Option, or CFCO, is part of the Affordable Care Act that each state has to authorize to implement.

Clarke Tucker, one of the few newly elected Democratic state Representatives, said the fate of the CFCO may be beholden to some of the same political forces affecting the private option. That includes a rift in the expanded Republican majority.

“I think the biggest area for that debate is going to be within the Republican caucus and so we’ll so where it comes out from their end. I think Governor Hutchinson is a good person to lead that debate for the Republican Party and I think Jonathan Dismang and Jeremy Gillam are two well respected effective leaders to lead their caucus in each chamber of the legislature. We’ll see where it comes out. But I think the CFCO and the private option will probably follow along the same lines,” said Tucker.

The Legislative Joint Auditing committee reviewed a report Thursday on the CFCO by the Department of Human Services. It found the state would save $365 million over a 12-year period if funding was allowed to be used to provide community based or home care instead of only for institutionalized care such as nursing homes and Human Development Centers.

State Representative Nate Bell doubted the projections.

“There’s hundreds of millions of dollars at stake on whether your projections are correct or not and you’re taking the most optimistic fiscal view of rather than the potentially pessimistic view of it,” said Bell.

The Republican from Mena also expressed concern that the CFCO would lead to declining funds for Human Development Centers. DHS officials said there is not an expectation, plan, or desire to reduce HDC funding. However the department does project when given the choice of community and home-based care the demand for institutional settings will decrease.

The cost of care for the disabled is also expected to grow in future years if the state is to comply with the Olmsted ruling determining the state is obligated to provide a level of care to the disabled. There are currently 2,800 Arkansans awaiting care, amounting to an eight year waiting list. DHS officials said the back-log is “indefensible” legally and estimated the CFCO would save the state over $900 million over 12-years if the state was to attempt to meet its legal burden.

Proponents of the CFCO say community and home-based care is not only increasingly the preference of an aging population but will help the state meet that legal obligation to its citizens in more cost-effective way.

The CFCO would also increase the amount of federal funds given to the state’s programs for the disabled by six percent.