Winona County leaders have been contemplating privatizing home health aide services for months, sparking concern from employees and clients alike. On Tuesday, board members heard from other counties that have made the switch, as well as from a representative from Winona Health who said the county needed to maintain the program for the most vulnerable clients.
Winona County has provided the in-home care services for more than four decades, stemming from a time when private companies didn’t offer home health programs. Initially, Medicare didn’t cover them, either, and when it picked up the expense in the ‘70s, it would only reimburse government entities for the work. That has all changed, with seven private agencies providing home health aide services in the county now.
Winona County has not accepted new clients in 10 months, and of the 84 clients left, most receive medical assistance that only reimburses the county for a small portion of the cost, rather than private insurance or Medicare, which covers more. Because the county receives less in reimbursement for the services, it has subsidized the program with the property tax levy in recent years to help cover the difference. As the client numbers have fallen, that subsidy has grown, with $211,289 in levy dollars spent in 2008, $380,099 in 2009, $472,592 in 2010 and $416,999 in 2011. Since 2002, the county has used more than $3.3 million in taxpayer dollars for the program.
Winona County Board members have questioned in the past whether privatization could mean some clients with low reimbursement rates, or no insurance at all, might fall through the cracks. Fears that the switch could mean that the home health aides currently employed by the county could be out of a job, or that similar private sector positions include little in the way of benefits, have also surfaced.
Tuesday, Mary Heckman, Deputy Director of Health and Human Services in Goodhue County, spoke to the board about Goodhue County’s experience in privatizing its home health aide services.
About 20 people were laid off, reported Heckman, which cost Goodhue County about $75,000 in unemployment costs and about $128,000 in vacation and severance pay. Those costs were defrayed by the sale of the county’s Medicare license for just under $500,000, she said, but added that was at a time when there was a moratorium on new Medicare licenses, making them much more valuable than today.
Heckman said the transition was stressful for staff and clients, but overall went well because the county’s former program director also switched to a private agency. Laying off longtime staff members, she admitted, wasn’t easy. “The staff that got left behind had difficulty dealing with it as well,” she said. “There [were] a lot of tears.”
Judy Barton, Public Health Director in Wabasha County, is currently overseeing the transition of her county program into the private sector too. All home health aides were given an opportunity to work for a private agency, she said, and most clients seemed all right with the switch since they were often being served by the same aide.
Commissioner Marcia Ward questioned whether the private agencies would really want, or be capable of handling, the clients the county currently serves, who receive very little reimbursement for the aide services through medical assistance and other programs.
Barton said Wabasha County, similar to Winona County, hasn’t had a client who receives Medicare or other higher-reimbursing insurance coverage, in years. She said when a person goes to the hospital and learns she will need assistance at home, she often is recruited right then and there with a brochure or other information on the private agency’s program. We end up with those clients who don’t get much reimbursement, she said, and without a more balanced spread, the county costs are just going to continue to rise.
Ward questioned whether clients who aren’t covered under those high-reimbursement programs would fall through the cracks without the county providing the services. If a person does not have any coverage or reimbursement source, Winona County conducts an assessment in attempts to find a program that can help, county representatives said.
Pam Slocum, Winona Health Director of Home Health and Hospice, said the state provides reimbursement if a person has no money, and said the Adith Miller Fund at Winona Health can help those not covered, as well.
If we privatize, asked Ward, will we see the “safety net” provided by the county shrink?
“The county needs to be here for some of those patients,” said Slocum. “There’s room for both [county and private providers].”
Barton told the board that private providers had told Wabasha County representatives that they needed the county to cover the gap, too. But, she said, when those private providers were asked whether they were willing to “share” the pool of Medicare and private insurance clients who have higher reimbursement rates, the answer was no.
Winona County Administrator Duane Hebert said there were different financial models and operating factors in the private sector, including tax implications and cash flow needs that could make it easier to absorb those clients with less coverage.
The board is expected to continue discussing the potential to privatize the service in the coming weeks. Keep reading the Winona Post for the full story.