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Alaska struggles to meet health care demands

State responds to moratorium imposed by Medicaid agency

Posted: Monday, August 03, 2009

While vulnerable Alaskans are waiting for home health services, a variety of state and federal elected officials are pledging to solve problems that have led to a federal moratorium on new clients.

New Gov. Sean Parnell has faced questions about the issue at his first two press conferences in Anchorage and Juneau, and discussed the complex issue at his administration's first cabinet meeting last week.

"The bottom line is we are taking steps to get Alaskans the care they need," Parnell said in Juneau, just after the cabinet meeting.

The immediate problem is a moratorium imposed in June by the federal Centers for Medicaid and Medicare Services (CMS). CMS supervises the state and federally funded program that provides home health assistance for the disabled and elderly.

The state needs a waiver to use federal money for the home care programs, which are 60 percent federally funded.

The moratorium was imposed by CMS for failing to meet federal requirements to receive the money after the state fell behind in its assessments of new applicants and reassessments of existing clients. Seniors served by the Medicaid program and disabled children or adults are eligible as well.

Parnell said 1,850 people were awaiting assessments to determine eligibility for services when the moratorium was imposed.

That was due to a difficulty in hiring enough registered nurses to do the assessments, he said.

"We have the money to do it, we just don't have the positions filled," he said.

The state Department of Health and Social Services is looking for ways to boost hiring, as well as the possibility of contracting out the assessments, he said.

Sen. Mark Begich said he obtained a pledge in a weekend phone call with U.S. Secretary of Health and Human Services Kathleen Sebelius to work to get the moratorium lifted and the problems that led to it solved.

"Sec. Sebelius gave me her personal commitment to find a quicker resolution to this situation," Begich said.

State officials say they're already taking steps to deal with the issue, such as hiring assessors who are not registered nurses.

And while progress has been made dealing with the backlog of assessments, 524 new applicants have joined the list since then, according to the department. Of those, 290 have been provided services through other programs.

Children with complex medical conditions approaching adulthood were poised to lose services, until the state's Senior and Disabilities Services program announced they will be able the apply for adult services despite the moratorium, with permission from CMS.

At Juneau's REACH, which provides services to developmentally disabled children and adults, Executive Director Richard Fagundes said he appreciated the effort the state has put into solving the problems and getting the moratorium lifted.

"It's a very serious issue, I don't want to suggest that it's not, but I know the state's working on it," he said.

Only three of REACH's clients were affected, but they were able to serve them through other funding sources, he said.

Department officials say they've hired a project manager to help with the response to the moratorium, and multiple programs that fall under the moratorium have made progress dealing with backlogs.

Among the assessments due or past due are 723 for personal care attendants and 412 for the Older Alaskans and the Adults with Physical Disabilities programs. Three newly hired assessors are working on each program, the department said.

Additional measures such as an electronic database to speed assessments and eliminate duplicate paperwork are also in the works, the department said.

A new system for evaluating deaths that occur while individuals are receiving services also is in the works, addressing another CMS concern, the department said.

• Contact reporter Pat Forgeyat 523-2250 or e-mail patrick.forgey@juneauempire.com.



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