Friday, November 11, 2016

Should Medicaid Pay Family Members to Care for Disabled Patients?

We now take a break from incessant discussion of the Trump transition, 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.

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