Working 4 You: Formula for Care-Lawmakers Concerned About Changes

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LITTLE ROCK, Ark. – All this week, Working 4 You has highlighted a program the disabled and aging rely on to stay in their homes instead of facing life in an institution. 

Through the ARChoices program, Medicaid pays for care hours in people’s homes, and DHS oversees it. 

About two years ago, the agency started pairing a computer algorithm with nurse’s in-homes assessments. As Working 4 You highlighted, that computer program has resulted in cuts to some people’s hours that clients don’t seem to understand. 

On Friday, we heard from lawmakers who also seem concerned by the changes. Two lawmakers voiced concerns to DHS as recently as two weeks ago when a young man with profound disabilities saw his monthly hours cut by 80 hours a month. 

Another lawmaker has received dozens of calls about cuts and wants to see the program reviewed and revamped. 

“It’s hard to make something that fits fo everyone…we need to make certain people don’t fall through the cracks, that people don’t get pushed into institutional care when home-based care is preferred,” says State Sen. Bruce Maloch (D) Magnolia.

Sen. Maloch emailed DHS staff about a constituent who had been receiving 243 hours a month for his home care, until he was assessed under the Arpath tool – and those hours were reduced to 161 a month, or 37 hours a week. 

Emails to DHS indicate the DHS nurse thought the patient should continue to receive the care he currently received. 

State Senator Jim Hickey also emailed about the client, saying a personal visit will leave no doubt the care is required, and if the data had been put into the assessment tool correctly…and we receive this type of info back…a person must infer there’s a flaw in the assessment tool.

“As those needs increase, we have to make sure we’re using the most effective and objective ways possible to ensure that all beneficiaries are treated fairly and accurately across the state,” says Craig Cloud, DHS Division of Aging Director.

Cloud also told us the assessment was able to capture an individual’s functional abilities and took those into account…and that the agency wanted to keep everyone in their homes if possible.

But in response to Maloch and Hickey’s inquiries, a DHS staffer explained that the decrease in hours from 243 to 161 is not an indication that we think [the patient’s] function abilities improved. Rather…he had been allocated more hours than the average client in the same rung…which triggered the reduction. In other words…the way DHS chose to allocate hours through the algorithm…which is based on averages…is what triggered the hour cut, not the client’s functional abilities.

“It makes me madder than a red hornet,” says State Rep. Josh Miller (R-Heber Springs). “To see these folks get screwed over, and that’s just simply – there’s no other word for it. These folks are getting screwed by the State of Arkansas due to actions of DHS and executive branch of this government.”

Rep. Miller says lawmakers should require a review of the allocation program and an explanation from DHS.

We have repeatedly asked DHS for data on the assessments. How many people have seen increases or decreases? How many have been placed in each group? DHS has been unable to produce that type of data. They apparently do not keep it on hand for their own review.

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