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Money Follows Persons (CBA)

    Back in the '90s, noting the rapidly expanding FedDebt required to fund Nursing Home Care, both red and blue politicians saw opportunity.  Not that "Community Based Alternative" CBA was fiscally significant but politically it served both sides well.  The Blues promoted returning frail elderly constituents to their nurturing communities by allowing dedicated Fed Dollars committed to Medicaid to support their sustainment out there...anywhere but in the Medicaid supported Nursing Home NH. The Reds talked possible percentage cuts in entitlement causing deficits.  Yes, it was kind of a win-win, politically, but as to improving the well-being of the nation's most vulnerable, not so much.

    For most Nursing Home patients, their mandatory 90 day In-Facility Stay was so debilitating that they were functionally unable to re-enter the community.  This was particularly so when the state & fed bureaucracy extended approval periods well past patient's life expectancies.  In some States, when even then, the Per Diem NH cost was $3000, to $6000,  assuming these funds were really reallocated to Community Based Residency options, it made a few Congregate Care Developers rich.  Mostly, however,  CBA was a second rate political spin game.

      So why mention it?  Well mostly just to conceptualize that Trump's past, present, and future fuckups are nothing new. Social engineering is almost always screwed up almost always.  Anyway, I wanted to example how one dubious program like CBA has survived and morphed over the last 25 years.  I don't know,about all States, but I do know a little about how it has been adapted to the Missouri political will.   Our States CBA initiative is called "Money Follows Persons".  It is alive and well under the Missouri Social Services Agency.  It has enabled a small staff of well educated but low apparitional persons to get steady employment for a couple of generations, and perhaps it has sent a few of our States poorest home......although only those who preachingly had been Medicaid Eligible, which by law meant that they could have no more than $936 monthly income and no more than $2000 in assets, and of course they had met the States "damn near ready to die" medical qualification test to have gotten admitted to the NH to start.

      How are these fortunate few awarded the CBA status going to make it out there in the community.  Other than their own diminished resources fullness, Missouri Department of Health & Aging will give then $2400 plus a few hours a week of In-Home support, specifically by an unlicensed and untrained, bottom of the labor pool, $10 hour, aide.  The State cost for this alternate care program is of course not the $6000 to $10,000 the State had been paying for skilled nursing care, but closer to $600.  This is astounding in it's immorality, but wait.... that's not all folks.

     If you didn't know the Missouri Medicaid Program that pays for virtually all NH care receives typically 60% of their cost in contributions from Washington.  Would you believe that when the "Money Follows Persons" group sends someone home from the NH, the Feds not only continue to pay Missouri Treasury, but they increase their payment by 30+ percent.  So when Orville goes home, the State gives him $2400 in cash, which is likely more than he has had in his life.  He spends it almost immediately and then again relies on his $800  SS or SSI check to survive.  Meanwhile Gov.Geitner picks up about $5000 for Orvills having been discharged.  GovIFightGeit can use the $60,000 a year however he pleases.  I guess he could use it to support, at the current Tax-emplt Bond rate, about $3,000,000 in debt which would be enough loose cash to buy a couple of Stinger Missies.

     The only light in this dark story is that the $60,000 that Washington will send to Geitner is money Trump has borrowed from the Chinese who can't stop loaning us money for fear we will make our own smart phones. If we can continue to screw China over for another couple of generations, without the great push-back, we may make America so great again that we can properly care for the vulnerable.....nay, let's just euphonize them.


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