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By: Clara Bates, Missouri Independent
Nearly 8,000 seniors and Missourians with disabilities could lose at-home care over the next year after a new eligibility algorithm went into effect this week, a spokesperson for the state health department told The Independent.

Starting Oct. 1, Missouri’s Department of Health and Senior Services implemented a change in the scoring algorithm they use to determine eligibility during annual reviews and enrollment for those receiving help with everyday tasks like going to the bathroom, getting dressed and taking their prescriptions. The assistance is part of a Medicaid-funded program called home and community based services designed to provide an alternative to those who would otherwise need to receive institutional care.

That change, according to the department, is designed to help ensure those who truly need the services receive them, and those who don’t — for instance, because their conditions have improved or they’re not severe enough to qualify — are removed.

“We want to ensure those with higher acuity needs are receiving the care they need,” said DHSS spokesperson Lisa Cox. “That is what this transformation is about—to ensure we are providing the right services, in the right setting, at the right time to those who would go into a facility placement if not for [home and community based services].”

But advocates are raising alarm that certain people who still need services will lose them, causing their health to decline or forcing them into institutional settings like nursing homes.

Jennifer Gundy, who runs a center for independent living in southwest Missouri, which provides in-home care support for 370 people, estimates 18% of her clients will fall off the rolls.

And most of them will still be in need of services, she said, including cases of those with severe diabetes, mobility issues, complicated medication regimes and other issues that are eased by current assistance but will worsen without it.

“So that’s our concern,” she said. “And we’ve been voicing that concern with the state for probably the last two years,” she said.

Joel Ferber, director of advocacy at Legal Services of Eastern Missouri, said there are “truly needy folks who are going to lose services.”

Legal Services of Eastern Missouri has been working with national advocacy groups to analyze the new algorithm and its effects, and provide guidance. One client they identified, a 70-year-old woman who receives 40 hours of weekly paid help, won’t be eligible after her review, according to LSEM. She weighs under 100 pounds and has had a stroke.

Without a caretaker, she won’t be able to make herself meals or bathe, and has no family in the area. She may have to be hospitalized or go to a nursing home.

Read in full here.

This article was originally published in the Missouri Independent and is reprinted with permission.