Elderly and disabled people are not typically considered to be the populations that can contribute to turning an economy around. Many people view the provision of services to these populations as one-way charity that simply comes out of the pockets of taxpayers into the pockets of those served with no return to society save for the satisfaction of “doing the right thing.” The reality is that investing in social programs creates new businesses, jobs, and more taxpayers and should be part of the new economic plan for America along with infrastructure projects and green technology.
Today, Medicaid waiver programs that provide home and community-based services to the elderly and disabled are dramatically under-funded on both the federal and state levels. Hundreds of thousands of people who qualify for, and desperately need services are not receiving those services in states across the country. In a capitalist society, it means there are hundreds of thousands of “customers” whose needs are not being met.
The ramifications on families are that caregivers must leave full-time careers to care for family members. Many of those caregivers would be working in careers that would have significant impact in society and they would be paying taxes on their income. Some of these families are forced into poverty and must also receive other public benefits in order to provide for their families. In an economy like the one we have today, even middle income families who are caring for an elderly or disabled family member are vulnerable to foreclosure and job loss affecting the only working person in the home.
The Medicaid program provides institutionalized care to elderly and disabled people. Section 2176 of the 1981 Omnibus Budget Reconciliation Act gives the Health Care Financing Administration the authority to waive certain Federal Medicaid regulations to allow the States to include home and community-based services in their Medicaid coverage. Institutionalized care costs significantly more per person than community-based care, but because of the lack of adequate funding in the Medicaid waiver programs, there is also a lack of service providers who can offer home-based nursing care, job coaching services, host homes, and other services. In a capitalistic society of supply and demand, the demand is there but the supply is not because the providers cannot get paid. Families cannot afford the out-of-pocket expenses for such care and insurance does not cover it.
If the federal government fully-funded the Medicaid waiver program, and re-examine the State match requirements, more service providers would emerge and more family care-givers would be able to return to their careers. Furthermore, individuals who are currently institutionalized could move into less-costly community-based care where they could live fuller lives. People with disabilities would also have new opportunities to also become employed, draw paychecks and obtain their own private insurance coverage.
As America re-thinks the way we do business, it is in all of our best interests to consider the needs of our most vulnerable citizens and to value their needs as part of our solution.