State: Assistance program overhaul to save $40 million

Overhaul: Aid targets people unable to work due to disabilities

November 19, 2009 

State officials say they have overhauled the controversial General Assistance Unemployable program, which gives cash and medical aid to people whose disabilities prevent them from working.

The changes are supposed to save taxpayers $40 million to $58 million over the next 20 months and also improve care for the approximately 17,000 people who qualify for aid under GAU.

The savings are supposed to come through better management of prescription-drug costs and fewer inappropriate trips to hospital emergency rooms, based on the results of pilot programs run by Community Health Plan of Washington in King and Pierce counties.

There is hope that care coordinators assigned to clients can help them get services they need more quickly and less expensively.

“The whole point of GAU is to get people back to a lifestyle that is self-sufficient,” said David Kinard, a spokesman for Community Health Plan of Washington, which now has a contract with the state to provide managed-care health services to all of the state’s GAU clients.

Community Health’s pilot programs in King and Pierce counties saved about $1 million over two years using a managed-care approach to medicine, and the hope is for more of the same statewide, said Kinard and Roger Gantz, the director of legislation and policy for DSHS.

To qualify for GAU, a person must be unable to work for mental or physical reasons for more than 90 days. Some of the clients are injured workers, some are homeless and some are veterans. Some might need retraining or await qualification for Social Security disability benefits.

Gantz estimated that “40-some percent” of GAU clients have a mental-health incapacity or diagnosis needing care. With mental-health and chemical-dependency treatment available for the first time through GAU, the hope is that participants will be able to get “their lives more in order,” whether it’s to pursue a job or new occupation after retraining, or as a patient who no longer uses the hospital emergency room as a primary source of medical care.

The program has been controversial, and Gov. Chris Gregoire proposed eliminating it as part of her budget proposal last year. But majority Democrats led by House Speaker Frank Chopp spurned that idea in favor of reforming the program and cutting costs.

Some Republicans, such as Rep. Gary Alexander of Thurston County, agreed with Gregoire’s original view, and he said recently that the state should cut the program if no federal money is found to pay part of its cost. Those cost concerns will be heightened in January, when lawmakers return to the Capitol to close a new $2 billion budget shortfall.

Spokesmen for Health Recovery Services say the changes should let them meet the Legislature’s goal of saving $40 million over the next 20 months in GAU medical costs. DSHS also is considering a nine-month time limit for participation in the program during any two-year period, Gantz said.

DSHS also is considering how to save an additional $18 million in reduced cash payments to clients, who can be eligible for up to $339 a month depending on work history, said Leo Ribas, who works for DSHS’s economic-services arm.

Ribas said cash grants average $310 a month. One suggestion is to cut it by an average of $10 to $12 a month. More recently, there has been talk of larger cuts of 11 percent to accommodate Gregoire’s order for agencies to cut costs even more.

In South Sound, the SeaMar clinic in west Olympia is expected to provide care locally for GAU participants. It is one of about a dozen clinics SeaMar operates in Western Washington.

“We have seen good results in King and Pierce. I don’t see why it wouldn’t work in other counties,” said Claudia D’Allegri, vice president for behavioral health services for the SeaMar system. Patients “really are getting better.”

D’Allegri said an “integrated care” approach using care coordinators frees up time for doctors to spend more than 15 minutes with a patient, which provides more time to learn about the patient’s symptoms and problems.

Thomas Barr, a Tacoma man who eventually qualified for GAU last year, said he suffered his fourth heart attack in 2007 while working as a hospital security guard.

“It saved my life,” he said Wednesday of GAU. “I would probably have been on the street and dead. I wasn’t getting … medical. I had had four heart attacks and didn’t have medical.”

Barr said the program had problems and that it was difficult to qualify.

“It wasn’t like GAU came up and said, ‘We’ll help you,’” he said. “You have four heart attacks. You think that should get you through the door.”

Eventually, Barr said, he went to a Tacoma advocacy group that helped him apply for, and receive, a Social Security disability based on his health problems. Now he said he’s trying to get the state to cut off his GAU benefits, including $339 a month that still is being transferred to his benefits card. He’s refusing to spend it while he tries to straighten accounts with the state.

“This part of it is mind-boggling,” Barr said. “Supposedly, they are going to cut it off now.”

Brad Shannon: 360-753-1688

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