Funding shifts affect county's needy

LECANTO -- The Big Budget Story is over. Lawmakers made their cuts, talked about them and then went home.

But the fallout continues.

Last week, after spending weeks calculating formulas and analyzing numbers, state officials finally announced how much Citrus will lose from the social services fund it uses to help its poorest and frailest residents.

So, how much is lost? Depends how you look at it.

At issue is the Community Care for the Elderly Program, which provides in-home services -- homemaking, meal deliveries, emergency alert alarms -- that allow seniors to live at home instead of checking into an assisted care facility or nursing home.

The program's money comes almost exclusively from state general revenue funds. It goes to a lead agency in each county, which then provides the actual service or hires someone to do so.

In Citrus, the lead agency is county government's division of support services, which subcontracts with a variety of firms.

The Community Care program was cut when the state's spending exceeded revenues. Citrus' share of the trim turned out to be $15,059, or roughly 3.6 percent of the total $415,162 spending plan, state officials announced Friday.

It could have been worse, for certain. And the pain was alleviated, somewhat, by the companion news that the state freed up $20,261 more for those frail, elderly Citrus clients who qualify for the state's Medicaid Waiver program.

The net effect then was more than a $5,000 gain.

"I think we can accomplish this transition. We should be able to get through this without damage to clients (receiving services) now," Dean LaFrentz said.

LaFrentz is executive director of the Mid-Florida Area Agency on Aging. The agency is more or less a middleman, receiving state and federal funds and then deciding which lead agencies will receive the dollars and spend them on clients.

Mid-Florida serves a 16-county area that includes Citrus; the agency recently renewed the agreement that calls for county government to serve as lead agency in Citrus.

A similar budget move -- subtraction from Community Care money and addition of Medicaid Waiver money -- also happened last year, before the state budget became a problem.

The $415,162 original budget was a reduction from the $448,654 Citrus had received the year prior; meanwhile, Medicaid waiver money was increased from $670,440 to $858,069.

The Medicaid Waiver dollars are attractive because the federal government provides 55 percent in matching funds for the Medicaid program but no dollars for the Community Care for the Elderly program.

But there are downsides, as well.

For example, it takes four to six weeks for the state to deem a new client eligible for Medicaid waiver. Citrus must serve that client during that time using the ever-shrinking Community Care pool of money; the Medicaid Waiver dollars aren't freed up until eligibility is established, according to Bonnie Saylor, fiscal administrator for the division of support services.

Meanwhile, the county is obliged by law to provide services for at least 30 days to any eligible client whom the Department of Children and Families refers. Again, that money is likely to come from the shrinking Community Care fund, not the growing Medicaid Waiver budget line, Saylor said.

Then there is the more basic problem: Not all clients are poor enough to qualify for Medicaid waiver. Community Care, meanwhile, has no income cutoff.

Lastly, Community Care is supported, albeit in small part, by a copay that clients must provide. The county can't assess a copay when the state is still determining eligibility for Medicaid waiver.

So the net gain of $5,000, though helpful in some ways, also poses a problem: According to Saylor, Citrus has more than 100 people on waiting lists and hasn't been able to serve many new clients for some time.

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