To Mel Story, it is a case of being penny-wise and pound-foolish.
His 87-year-old mother, Marjorie, could lose her Medicaid coverage and her ability to pay for her care at Westwood nursing home. Her income is $400 a month too much to qualify after the state lowered the income limit to save $9.7 million in state funds next fiscal year.
There is a way to create a trust and keep her in the home that eventually would pay the money back to the state after she dies. The savings, Mr. Story said, are negligible in light of the changed income limit, which will affect as many as 1,900 nursing home patients beginning July 1.
"It is absolutely ridiculous," he said.
Facing a severe budget shortfall, the state Department of Community Health was forced to drop some programs that provided Medicaid for those whose income was well above the federal poverty level. For instance, an estimated 9,000 pregnant women making more than $17,000 a year will not receive Medicaid coverage and might not get prenatal care.
On Friday, the Georgia Department of Human Resources issued a statement saying it was studying which of its programs might provide coverage for the women and hoped to have a plan Tuesday "with some specific steps on working through the issue."
While there are programs in the Georgia Division of Public Health that provide care for pregnant women, there are concerns that they might not be enough.
The Richmond County Health Department no longer offers its perinatal case management program, said facility administrator Jane Oglesby.
"I don't have a nurse that is trained to do it," she said.
The state also has a Regional Perinatal System of six hospitals to ensure services for low-income women with high-risk pregnancies, which might cover some of the women who would not qualify for Medicaid. The regional provider in Augusta is Medical College of Georgia Hospital and Clinics.
Hospital spokeswoman Deborah Humphrey said no one would be made available to answer questions.
Public Health programs also have received their share of cuts and might not be able to handle the extra load, said Frank Rumph, the East Central Health District's director.
"We don't have the resources to absorb this, actually," he said.
Senior advocates had warned that the cuts might put some nursing home residents in a precarious position, said Becky Kurtz, the state's long-term care ombudsman.
"We're very concerned that those individuals may end up being discharged, and that's what we said to the legislators," she said. "They were very difficult decisions the Legislature had to make about cuts in the budget this year."
Families and advocates are scrambling to look at alternatives, such as a Qualified Income Trust or Miller Trust, Ms. Kurtz said. The irrevocable trust would absorb any income above the Medicaid eligible level of $1,692 a month and allow the patient to stay on Medicaid. The money would then be used to reimburse the state after the patient's death.
"Eventually, Medicaid is going to get all of that money," Ms. Kurtz said. The problem is that the trusts weren't previously allowed in Georgia, so few attorneys know how to do them, although many are quickly learning, she said. The Georgia Bar Association is holding a training session June 22.
Mr. Story is appealing the state's decision to drop his mother, who needs a feeding tube and is unable to care for herself, he said. Nor can he care for her.
"There is no alternative for her," he said. "She has to be in a nursing home." And the state will get about the same money in the end, he said.
"(It's) just costing the state money and creating piles of paperwork for the state," he said.
Reach Tom Corwin at (706) 823-3213 or firstname.lastname@example.org.
For more info
Those who have questions about creating a Qualified Income Trust to maintain Medicaid eligibility or other options can call the Georgia Senior Legal Hotline at (888) 257-9519. The hot line is open from 9 a.m. to 3 p.m. Monday through Friday. Pregnant women or new mothers can call the Healthy Mothers' Powerline at (800) 822-2539 to learn what local resources might be available.
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