Invest in Connecticut’s Continuum of Community Care Before It’s Too Late


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For patients with severe mental illness, home behavioral health may be one of the few, if not the only, connection between them and the community in which they live. As part of a larger set of services known as skilled home health care, home behavioral health enables these patients to receive physical and mental health care, as well as administration and monitoring. medication, in the comfort of their own homes, rather than in a large facility. such as a skilled nursing facility, residential psychiatric hospital, or correctional facility.

According to Connecticut Association for Home Health Care, skilled home health services saved the state more than $ 500 million in Medicaid costs over the past decade. Functioning as the only place of care designed to respond to acute changes in complex medical conditions that, left untreated, send patients to hospitals and other institutional settings, skilled home health services are a major driver of savings within of the Connecticut Medicaid System.

However, reimbursement rates for essential skilled home health services have been stable since 2007, and behavioral home health services have been reduced by 15 percent in 2016. The result of the state’s neglect to invest in qualified home health programs in almost 15 years, is a sector under significant financial pressure as there is a direct relationship between reimbursement and the capacity of health care providers to invest in clinicians and services. capabilities.

Fortunately, Connecticut now has the opportunity to remedy this situation. The state is currently developing its plan on how to use a temporary 10% increase in its Federal Medical Assistance Percentage (FMAP), which was included in the recently passed American Rescue Plan Act of 2021 (ARPA). It is critically important that Connecticut use these funds as a means to provide temporary but much needed investments in its continuum of community care. For the community care system to function properly, the entire community care continuum must be healthy. Connecticut’s decision not to make a single investment in skilled home health services over the past 14 years is clearly unhealthy.

Without skilled home health services, many patients, including those enrolled in personal care programs, would not be able to stay in their homes and communities. Never has this care been as important as during the last 15 months of the COVID-19 pandemic.

As an example, consider the real story of a 30-year-old patient who lived alone in Bridgeport, with a primary diagnosis of paranoid schizophrenia. When the COVID-19 pandemic struck, her community took charge of either converting to remote service delivery through telehealth or shutting down altogether. Her behavioral home care plan required skilled nursing care to deal with significant physical health issues concurrent with her diagnosis of schizophrenia and the administration and monitoring of her medications – services that simply could not be “suspended.” Or successfully delivered “remotely” for that patient.

For months, the only person in this patient’s home each day was his home behavioral health nurse. In fact, he was so dependent on his myriad of services that after losing them, he asked his behavioral health nurse how he could eat, as the person who traditionally helped with meal delivery and preparation was not coming. more at home. Fortunately, the nurse was equipped to act quickly and ensure the placement of a home health aide to allow the delivery and preparation of meals for the patient. This is why he was able to stay in his community throughout the pandemic, and still does today.

I use this example because it frames the criticality of consistent service delivery from home behavioral care providers under any circumstance. Despite the great challenges and personal risks of delivering healthcare during the pandemic, Connecticut’s home behavioral health clinicians have come forward for their patients every day, as they always do. While this commitment makes all the difference for their patients; The daily efforts of these clinicians are also critical to the health and effectiveness of Connecticut’s larger continuum of care.

Recent proposals to use $ 200 million in ARPA funds to increase personal care worker wages to $ 21 an hour and call for more funding for pediatric home care providers indicate real and significant needs, and although they are substantial, they also do not represent the best use of temporary ARPA FMAP. stimulate or provide long-term solutions to stabilize Connecticut’s continuum of community care, damaged by COVID-19. Instead, Connecticut is expected to use the ARPA FMAP boost to provide a temporary 10% tariff surcharge for all qualifying home and community services (HCBS). This simple, straightforward approach will bring some relief to every segment of the continuum of care, allowing the Connecticut legislature and Governor Lamont’s administration the time needed to plan for the longer term.

While terrible in every way, the COVID-19 pandemic has clearly demonstrated our fundamental interdependence with one another. The same is true of our health systems, each component must work together with the other to deliver the maximum benefit to patients. We sincerely hope that Connecticut policy makers take this basic truth into account and prove it in Connecticut’s ARPA FMAP plan.

Cale Bradford is the head of government relations at Caring elara, one of the nation’s largest home and community health service providers and provides daily care to 60,000 beneficiaries in 16 states with more than 3,500 behavioral health clients in the Bridgeport, New Haven and Hartford areas, Connecticut.


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