According to an article in the Charleston Gazette on August 19th, the A/D waiver is frozen again. I received a phone call from a concerned provider on Tuesday that this appeared to be happening, though there had been no communications about it from waiver administrative staff to providers, waitlisted applicants, or advocacy organizations. As far as we know, there still has been no such communication to any of these interested parties regarding when the freeze will end, whether new applications are still being taken, how long the waitlisted people (some who have waited 6 months already) should expect to continue to wait, and how we can best help the vulnerable population at this time.
Advocates are presuming that the freeze was prompted by the administration's presumption that the program's waiver renewal application to CMS will be approved. As far as we know, it has not been approved yet, though again there has been no communication about it. The 5 yr renewal application included a drastic reduction of slots from current 5,400 to 3,900 in the first year and down to 3,450 in the second year. Perhaps administration will freeze the waiver for a year, since there are probably already over 3,900 active waiver slots being used now (I've been told but haven't been able to verify that there are approximately 4,000 on right now). If that's the approach they're taking, it would mean those folks who've already been on the waitlist for 6 months might have to be on the waitlist for a year and a half total.
Another unsettling figure I heard, but haven't been able to verify, is that only 5,200 slots were filled in FY04, 200 less than the 5,400 available according to the waiver approved by CMS. Why did the waiver renewal propose to cut this valuable program to serve 2,000 fewer people annually? Why has there been a 6 month waitlist, which is not a waitlist in the true sense of waiting for an available slot, but rather just a standard 6 month wait for every single applicant? Why didn't 200 more people who were waitlisted when slots were available get served in FY04? Money, of course. The state spends less money by serving fewer people total, and by making people wait so long some will die, get placed in a nursing home, or give up trying during that 6 months of sometimes desperate waiting. Though we can all understand that fiscal times are hard (though didn't we actually have both a total state budget surplus, and a Medicaid surplus last year?), and that to balance a budget without additional revenue you have to cut spending. But these are some of our state's neediest people, and for them this program means the difference between institutionalization, inadequate care, or at worst abuse and neglect, and getting to continue to live well at home. How can anyone say there's absolutely no other spending in our state budget, even in the state Medicaid budget, that can't be cut to save these services.
These cuts and freezes of the A/D waiver certainly take us backward in our state's efforts to uphold its obligation under the Olmstead doctrine to provide services in the most community-integrated setting reasonably possible. And the lack of open dialogue, or even one-way communication from the administrators of the program about what's happening, are harming these vulnerable West Virginians further. It is outrageous that people actually on the waitlist would have to learn about this freeze from the newspaper.
