Columbia, SC (The Greenville News) -- There were also 903 people with mental retardation or a related disability living with a caregiver who was 72 or older, Mole said, adding their care could be jeopardized at any time if the caregiver's health deteriorates.
McPherson said a consultant's report recently distributed to commissioners recommends a different structure to Medicaid waiver programs. She said she would be concerned about any move in which the agency reduces care to some people who need it in order to address the waiting lists.
Greenville commissioner Rick Huntress said he's not making any snap judgments about whether cuts will be necessary, saying it's public knowledge that the $40 million was onetime funding.
Reductions in care would only come as a last-ditch move, he said.
Faced with crowds of disability advocates in the State House lobby earlier this year, some Upstate lawmakers said they are convinced the agency's funding for the most vulnerable citizens needs to be maintained even in tough budget times.
McPherson said the earlier the public is involved, the less likely it is that residents will be opposed to changes and the better the ultimate service will be.
Waiver programs - those in which Medicaid funds pay for care outside of an institution - require a lengthy run-up with the state Department of Health and Human Services in the driver's seat, Mole said.
Any changes that would take effect next July 1 would have to go to federal authorities no later than 90 days before. That means an agency advisory committee and the commission would both have to vote on the issue before that, pushing public hearings into previous weeks and the initial public release of proposed changes to January or February, Mole said.
Unlike the changes that covered in-home care last year, Mole said the new process would provide more concrete information in writing earlier in the process and those families who would be affected would be consulted earlier. Hopkins said she is cautiously optimistic about the new process but that families are intent on being heard as early as possible - before state authorities have made decisions.
"It's something that we'll just have to see," she said.
At issue is the long process required to make any changes in Medicaid programs such as the one that covers in-home respite care and previous arguments from consumers that they weren't given adequate input until it was too late.
Mole said there will be a new process for any changes to Medicaid waivers aimed at getting the maximum input from people who have to carry the consequences.
She said the public notice of any changes could begin in January, while McPherson said the process could need to start this fall.
The agency's new director, Beverly Buscemi, already has begun talking to consumers and providers about the temporary nature of $40 million in state funding and asking them to address an uncertain future that could include a mid-year budget cut or flat funding in the face of rising needs, Mole said.
"We haven't had this kind of a problem before," Mole said, referring to the one-time funding. She added that the agency is grateful for all the funding it received this year, temporary or not.
Everything, she said, is on the table.
Even if the agency doesn't have to make further cuts, Mole said there is the issue of waiting lists that keep getting longer and how the agency will maintain the quality of care.
She said 1,992 individuals were waiting for community residential services as of June 30, while 1,278 were waiting for day services, 1,870 for the Medicaid waiver that covers in-home care and 372 for the waiver for head and spinal cord injuries.
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