9 Investigates: Changes in Medicaid mean some won't qualify to stay in assisted living facilities

by: Linzi Sheldon Updated:

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CHARLOTTE, N.C. —

There are major new changes in Medicaid effective Jan. 1, 2013 that mean thousands of elderly and disabled people across North Carolina will no longer qualify to stay in assisted living facilities.

Leona Bess, 95, is experiencing the effects of the changes firsthand.

Two years ago, she fell and broke her leg. Her grandson, Stan Nantz, said she now needs help with her medications and bathing.

So she moved to Carillon Assisted Living Center in Lincolnton, paying for the stay out of her own pocket.

But when her savings ran out in September, Bess had to apply for Medicaid.

"I actually thought that, you know, this is something that will be there," Nantz said.

But the facility's director gave them some surprising news: that the standards for Medicaid were getting tougher, and that while Bess would have likely qualified under current standards, she did not need enough help to qualify come Jan. 1.

So Bess moved back to her house, where her daughters and other family members have taken turns staying with her.

"I would have never thought that a 95-year-old woman would basically be, I feel, swept under the rug and out on the street," Nantz said.

State health officials, advocates for assisted living facilities, and lawmakers all call the changes an "impending crisis."

According to the N.C. Department of Health, under current standards for receiving Medicaid, elderly and disabled people who get help in their homes must require hands-on help for at least three activities of daily living, like bathing, eating or dressing. They can also qualify by needing help with two activities of daily living, as long as one is at an extensive or total level of need.

People who receive help in facilities need to require only hands-on help for one.

But now the federal government is requiring that the standards for both are the same and legislators have chosen the higher standard.

It means approximately 20,000 people in North Carolina on Medicaid in assisted living facilities will be assessed by the end of November.

Health officials estimate about half of them, 10,000, will no longer qualify for care.

"Probably my greatest concern is the stability and security of the housing for these folks," Secretary of Health Al Delia said. He's said he's not sure every county has enough appropriate housing to take in all those people.

Delia said patients can appeal their assessments and keep their care in the interim, which he expects nearly everyone to do.

"Is the state prepared for that?" Eyewitness News asked.

"Well, that's one of my concerns," Delia said.

But Rep. Justin Burr defends choosing the higher standards.

"If it's an appropriate number for people to receive personal care services in their home, I believe it's an appropriate number for someone to have to receive personal care services in a facility," he said.

He said the state set aside $39 million to make sure people can stay in their facilities while they appeal. He said he doesn't believe the N.C. Department of Health's estimates and wants to see the assessments findings for himself.

Burr said he and the rest of a special committee called the Blue Ribbon Commission are working with housing experts to determine the next steps.

Bess has added her name to a long waiting list for a local program that provides some in-home care. 

Her family said Burr and other lawmakers need to figure out quickly what they're going to do to help her and thousands of others who will now need community help.

"I'd like to say to him, put yourself in our shoes," Nantz said. "Where would you be with one of your loved ones and our resources? How would you feel?"

The Blue Ribbon Commission has been meeting through November and will meet in December as well. Burr said it plans to lay out its recommendations to the General Assembly in January on the next steps needed to handle the changes.