Delores Mayfield, a Medicaid home-care beneficiary whose income is now too high for the program
Delores Mayfield, a Medicaid home-care beneficiary whose income is now too high for the program Credit: Darrow Montgomery

The Bowser administration says the District cannot afford to pay for home care for seniors who have lost their Medicaid eligibility.

The D.C. Medicaid home-care program recently began enforcing the income cap of $2,200 per month that federal rules require for screening applicants. The home-care program is designed to keep the elderly and physically disabled in their homes and out of nursing facilities.

D.C. found 106 participants in the home-care program who were over the monthly income cap, most by less than $1,000. D.C. Medicaid spent about $23.7 million on those individuals in 2016, largely for home-care aides, but also for case managers, doctor visits, and some hospital costs. That averages more than $200,000 per person.

The federal government reimburses for 70 percent of the District’s Medicaid costs. D.C. could create a local program for home-care for seniors who are not eligible for Medicaid, but it would have to pay the full cost per person. The federal government wouldn’t share the cost. 

“Given national uncertainty and pending plans to curtail federal spending on Medicaid, committing millions of dollars in local funds is not a long-term solution,” says Kevin Harris, Mayor Muriel Bowser’s communications director.

Councilmember Vince Gray, who chairs the Health Committee, said in a statement to City Paper that he would support maintaining home care for those dropped by Medicaid.

“If Mayor Bowser includes local funding in the budget to support allowing the seniors who were ruled ineligible for this program to continue to receive services, I would heartily support doing so, and would fight to keep that funding in the budget,” he said.

If seniors who can’t afford home care end up in nursing facilities, it might ultimately cost taxpayers more. Medicaid will pay the portion of a nursing facility’s bill that exceeds a patient’s income (even if the person is not poor), but it will not do the same for home care.