Banishing the disabled.

• Author: Conniff, Ruth
• Position: Wisconsin caps home-care reimbursement

On New Year's Day, hundreds of disabled people in Wisconsin suddenly confronted the prospect of entering nursing homes. The state budget, passed last fall, placed a cap on funding for community-based services, including personal-attendant care. On January 1, the state began enforcing the cap. Anyone whose home care costs more than the cap was directed to the nearest residential-care facility. This has caused a wave of fear and outrage among the disabled.

"I was in a nursing home once, and believe me, I don't ever want to be in one again," says Steve Verridan, who suffered a spinal-cord injury in a diving accident. He now works at Access to Independence, a nonprofit agency in Madison, Wisconsin, helping other disabled people find home care. When the new law went into effect, Verridan--like many of his clients--had to call ten nursing homes within a fifty-mile radius of his home in order to prove they wouldn't take him. Unless his phone calls earn him an exemption, he could find himself back in an institution. "Of course you're calling these places hoping like hell to be turned down," he says.

What's happening in Wisconsin marks a dramatic shift in the way the federal and state governments treat medicaid, the program that provides health care to millions of poor, elderly, and disabled Americans. Republicans in Congress have proposed cutting federal Medicaid funds by as much as 30 percent over the next seven years. And politicians of both parties--from President Clinton to Wisconsin Governor Tommy Thompson, who is the head of the National Governors' Association--are advocating giving the states more flexibility to try cost-saving experiments.

"Taxpayers can no longer afford open-ended Medicaid entitlements," a memo from Wisconsin's Department of Health and Social Services explains. "For the first time in recent history, Medicaid recipients must make the same choices about care setting as private-pay individuals."

Thus, people with disabilities in Wisconsin have become the most reluctant of shoppers, making their phone calls to nursing homes, and praying for rejection.

"We've gotten several calls ... I've mostly talked to people in their twenties or thirties who are going to school and have jobs," says Maureen Griffin, the admissions coordinator for City View nursing home in Madison. "It's hard. I'd hate to see anyone go somewhere they don't want to be, and it seems like most of them don't want to be here. They're just looking for a `no' answer."

Unfortunately, she says, she can't always tell her nervous callers what they want to hear.

"In some scenarios, we'd be able to meet their needs. Most often I've been saying yes, and then they try to get off the phone in a hurry.... There's been a couple of people I've been able to say no to because they needed transportation provided, or they had space needs, they had a pet, something like that."

According to the state, sympathetic nursing-home staff have been handing out excuses too readily.

"The state has sent out notices saying these reasons aren't good enough," says Ray Froemming of the Wisconsin Coalition for Advocacy, which is...