Should Medicaid Pay Family Members to Care for Disabled Patients?

care-home_2063592bWe now take a break from discussion of the Trump transition (to which we will surely return), to bring up a very delicate subject: How to ensure severely disabled patients do not become victims.

What politician could ignore the pleas of families caring for disabled members, asking for some help with the burden they carry? Unfortunately, government funding this type of personal care cannot deter significant unintended consequences.

The Office of Management and Budget (OMB) has designated 16 programs as “high error” which means money goes offside due to fraud, waste, and abuse. Medicaid, the joint state-federal program that subsidizes medical services for low-income people, ranks highly on the list. $29.1 billion, or almost ten percent of the $297.7 billion federal contribution is considered by the U.S. government to be paid “improperly.”

The Department of Justice under President Obama has had significant success tracking down and charging those who bill Medicaid and Medicare falsely. However, there is an even worse type of abuse happening in Medicaid: Actual physical abuse of the most vulnerable patients in the system. This often goes hand-in-hand with financial fraud in the area of personal-care services.

According to the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services, Medicaid spending on personal care of disabled people in their homes has grown since a 1999 judgment that many people with disabilities were being institutionalized in violation of their civil rights.

As described by Kaiser Health News’ Melissa Bailey, personal caregivers funded by Medicaid have been charged with severe neglect, leading even to deaths of disabled patients. Three quarters of caregivers funded by Medicaid are family members, and they are among the culprits.

Many states have sought to impose more training and oversight of caregivers. Is this a solution? Well, I am skeptical. Headlines might cause political reaction, but once the horror stories drop off the front page, the bureaucracy will likely go back to business as usual.

Although many politicians assert family caregivers of children, aged parents, or the disabled should receive even more government subsidies, there is a strong moral argument to be made that if a family member does not have a sense of duty towards his kin, he is not likely to acquire one along with a check from Uncle Sam.

Some of these victims are so disabled and vulnerable that it is unlikely any level of normal human oversight of caregivers can prevent abuse. However, when family members fail, there are alternatives. The recent canonization of Mother Teresa reminds us that some (admittedly very few) people are immune to the incentives governing the rest of us, and will care for the most vulnerable without hope of profit or political reward.

There are things we can do to support these people in their mission. Unfortunately, the current U.S. Administration prefers to impose rules and regulations that interfere with their calling. This was recently exemplified by the absurd Little Sisters of the Poor lawsuit on artificial contraception.

The type of people who succeed in politics have different characters than these charitable souls, who are not swayed by the hope of a government paycheck.

Comments (4)

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  1. Ron Greiner says:

    No John, we should not pay children to change the diapers of their old parents. People should want to help their old parents without getting a government check.

    We should now work on shutting down corrupt Medicaid by encouraging the poor to volunteer to leave that bogus, extremely over-priced and ineffective system, which won’t be difficult.

    Devon says that a family of 4 on Medicaid costs us taxpayers $26,000 a year. Devon also says that doctors won’t take Medicaid so the full $26,000 goes to the Medicaid CEO and then he has no expenses. See, that’s too corrupt.

    A poor 30-year-old couple with 2 children will get an age-based tax credit of $7,000 to purchased insurance under President Trump so the taxpayer will save a whopping $19,000 per poor family and the poor healthy family will be able to purchase REAL health insurance for just $6,000 so the extra $1,000 will be deposited into the family’s tax-free HSA which they can use for 1st dollar medical, dental or vision expenses.

    Sure, it seems like we are paying poor people $1,000, tax-free, not to take worthless dangerous Medicaid, and save the taxpayers $19,000 a year, but that is just the MAGIC of the tax-free HSA and the way they roll. Don’t you love it?

  2. Janice Michaud says:

    Thank you John for pointing out the soft side of care giving.
    Caregivers are the very people who should be allowed to define their relationships with those they care for without having their relationships “institutionalized” by the DOL.

  3. Ronald Greiner says:

    Paul Ryan was just re-elected. His Better Way:

    When it comes to repealing the Affordable Care Act, A Better Way called for ending Medicaid expansion efforts in the 31 states that have undertaken this project. This means that millions of low-income Americans who received coverage through Medicaid expansion would be losing it. The replacement plan did not address how these individuals would be able to have insurance.

    Tom Price (New HHS Chief?) and his age-based tax credits is a Better Way to finance Medicaid.

  4. Jimbino says:

    Insurance is a religion. Forcing anyone to take insurance is a human rights violation. Americans need health care, not insurance with its 80% of the healthcare premium paid out for actual health care.

    Using forced insurance to transfer income and wealth from the young to the old, from men to women, from the healthy to the sick is also a human rights violation. The fact that Social Security does it does not make it right, though Social Secuity is worse in that it’s also a Ponzi scheme and covers disability and dependents including up to 5 current and ex-spouses of the listed beneficiary. Medicare also covers indigent spouses. Only Medicaid, being the last resort for the poorest, can be justified in the interests of human rights.

    A person who suffers a sudden, unexpected loss need not declare bankruptcy if he can arrange a payment plan. That’s how kids now get through college. Furthermore, college tuition will get cheaper when the kids get saddled with ever more of the burden. Health care will also get cheaper once the patient pays with his own dollars, from an HSA, from family or personal loan.