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Elimination of Medicare Subsidy Worries Health Care Providers in Rural Areas

By Elizabeth A. Weiss
Capital News Service
Friday, April 22, 2005

WASHINGTON - When Dorothy Leuba, 83, left her life as a Baltimore City school teacher and moved out to the country in Garrett County, she left behind theater outings and board meetings -- but not access to health care.

Thanks to home visits by health care workers, Leuba does not need to finagle a ride to town for physical therapy on her broken leg -- or go without therapy -- after her doctor ordered her homebound.

But that type of service could be endangered, after a Medicare subsidy that helped pay for health workers' travel expired April 1. A bill in Congress would reinstate the add-on through March 31, 2007, but in the meantime officials say they will have to pull resources from other areas in order to keep the program going.

"It has a significant impact on our bottom line," said Rodney Glotfelty, health officer for the Garrett County Health Department.

The home-care visits that people like Leuba depend on are especially costly in rural areas, because of the time and expense for workers to travel from place to place. Rural home care providers have received a Medicare subsidy in the form of a 5 percent add-on for years.

Glotfelty said that without the Medicare add-on, his department's expected deficit will increase as much as $40,000 this year. That, on top of state-mandated pay raises, could push last year's $135,000 deficit to $206,000 this year.

Bill Dombi, vice president for law for the National Association for Homecare and Hospice, said that rural home care providers lose an average of 5 cents on every dollar they spend. In Maryland, the loss is more than 12 cents.

Garrett County has the only public health department in the state that still maintains a Medicare-certified home care health agency. It also has lowest population density in the state, said Glotfelty, adding that home health workers logged over 70,418 miles taking care of patients in the county.

"We're in the far western region of the state, isolated, and have anywhere from 400 to 500 patients a year that depend on these services," Glotfelty said. "I have dozens of letters that tell me how invaluable these services are."

"A lot of times, we're the only people that they see on a weekly basis," said Linda Moe, director of home health services for Garrett County. She said many have no close family or no family at all.

But it is not just the elderly who subscribe to this service: Homebound children also receive home care visits, Moe said.

Glotfelty said his department will have to start pulling resources from other, less-critical areas like health education programs, since the home care service is not self-sufficient.

"We have never denied them that service," he said. "If you can't get more local money into the budget then we have to divert money from elsewhere in the department."

He said the rural add-on has been invaluable in the past and he hopes Congress can work it out and restore it the subsidy.

"I personally think it should be 10 percent" as it was in 2001, Glotfelty said. "We're going to continue to try to make ends meet."

Rep. Wayne Gilchrest, R-Kennedyville, agreed there is a need for the rural home care visit service, and sees that need in his own district on the Eastern Shore. But he also said that the responsibility extends beyond the government.

"There really is a need for it, there's no question," Gilchrest said. "But the other thing that there's a need for is family, neighbors, and friends to come by and help out."

But for people like Leuba, who was widowed 20 years ago and likes her independence on Deep Creek Lake, rural home care is vital.

"This is an excellent service, it really is," said Leuba, who plans to continue her therapy so she can go on a planned cruise in June.

"I might have to take a cane," she said, but "I'm a determined old lady."


Copyright 2005 University of Maryland Philip Merrill College of Journalism

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