Gov. Nathan Deal entered the debt ceiling debate asking that Washington lawmakers avoid adding a copayment to home health care services covered by Medicare or Medicaid, saying such a change would push seniors into nursing homes.
"Through my personal experience as a caregiver for my mother and my wife Sandra's parents, as the former chairman and ranking member of the Subcommittee on Health and as governor for the State of Georgia, I am confident such a copayment requirement would only serve to shift thousands of low-income seniors out of home-based care into much more costly nursing homes and impose billions of dollars in additional Medicaid costs onto the states," Deal wrote in a letter sent last week to U.S. House Speaker John Boehner.
Lawmakers in Washington are debating a range of possible cuts to Medicare and other programs as Congressional leaders and President Barack Obama consider plans to raise the national debt limit.
Medicare, the government health care program for the elderly and disabled, does not charge a copay for home health care, even though it charges such a fee for most other services. Doctors can order home health for Medicare patients to provide part-time skilled nursing, various types of therapy and social work to beneficiaries who have difficulty leaving their homes.
A Medicare advisory committee in March recommended a copay for home health to combat unnecessary use of the services. Medicare's home health spending has increased significantly in recent years and raised questions about fraud and abuse in the program. Adding a copayment of $150 for a series of home health visits could save Medicare between $1 billion and $5 billion over five years, the group estimated.
If such a change pushed more low-income seniors into nursing homes, Georgia could end up paying a portion of those extra costs, since many low-income Georgians are covered by both Medicare and Medicaid. The state is already struggling to pay for its Medicaid program.
"This would simply shift a huge burden to the states," said Brian Robinson, a Deal spokesman.
Robinson said the governor does not oppose copayments across the board for health care programs. But he said they do not make sense if the end result is driving up total spending.
He said Deal believes the incentives should entice people to stay at home. "That's where they want to be and it's a lot cheaper," Robinson said.
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