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Making the business case: "Night job" for MSSP staff
After the Multipurpose Senior Service Program (MSSP) was targeted for elimination in January 2011, the program's staff put together their own analysis to prove the cost savings achieved by the program, reports Eileen M. Koons, MSW, ACSW, director of Huntington Senior Care Network.
"Our fact sheet is based on the most recent data available, which was provided by the administration to the federal government," she says. "It calculates the break-even point. This was verified with a long-term care financing expert."
The analysis is based on the CMS 372, a publicly available cost comparison report required for Medicaid waiver programs. "It was a matter of finding a way to tell the story of the budget impact," says Ms. Koons. "The other story, of course, is the human impact."
While Ms. Koons agrees it's impossible to know exactly how many of MSSP's 11,000 participants will enter a nursing home if the program ends, she says it is possible to calculate the cost savings of the program.
"You can take the verified information on how much this program saves, and simply calculate how many people it takes, if the program were eliminated, before you stop saving and start adding to the deficit rather than reducing it," says Ms. Koons. "That number came out to 18%."
More costly services
Ms. Koons says that the program's end will drive many people into more costly services. She and her staff set out to do "everything possible" to educate legislators, the Governor's office, budget staff, and the community about this.
The efforts, says Ms. Koons, included surveying MSSP providers statewide to get a sense of the job loss entailed, doing an analysis of the negative economic consequences such as the loss of $20 million in federal matching funds, and also doing a lot of educating about MSSP activities.
"We have the added challenge of being a tiny little budget dust in the grand scheme of things," says Koons. 'We are also a program that serves a niche population and coordinates with other services. People who aren't really listening for the nuances can confuse us with other services that are available."
Ms. Koons says that defending the program's existence became a "night job" for staff in the network of 40 agencies. "We have had to spend an enormous amount of energy to see that people have a better understanding of what we do," she says. "It's not just the nice thing to do. There is a business case to be made for retaining these services."
These efforts did help some legislators to understand the program, according to Ms. Koons, but she is unsure whether this will make any difference in the end. "It's a scary time now. We have to assume and prepare for the worst, while hoping for the best and fighting like crazy," she says.
Meanwhile, the program is working with statewide partners to come up with alternative proposals, says Ms. Koons.
The number-one question now, she says, is what happens to the 12,000 participants if the program is cut. "We've never gone here before," says Ms. Koons. "Some may move in with family members, or a family member may quit their job to care for them, but for the vast majority, I don't know what the answer is."
If the MSSP program is eliminated, Ms. Koons says that she doesn't see it coming back. "Once California has walked away from a nearly 30-year investment, a safety net for people as an alternative to nursing homes, that is a very expensive resurrection," she says. "Will this program come back in two years? I don't see that happening."