By Joe Biesk
The Associated Press

FRANKFORT - More than 1,400 Kentuckians currently cared for in nursing homes, their own homes or other community-based settings are no longer eligible for long-term-care Medicaid benefits under more stringent eligibility rules, the state's Health Services secretary said Monday.

Between April and July, the state has "decertified" or denied admission to 198 nursing home residents, Cabinet for Health Services Secretary Marcia Morgan said Monday.

That accounts for less than 1 percent of the state's nursing facility residents, Morgan said.

The state has also decertified or denied admission to about 1,209 patients who were living at home or in community settings, she said.

Earlier this year, the state eliminated the "personal care" category of Medicaid service intended for recipients. Aimed at helping close its Medicaid budget shortfall, the state announced the sweeping changes to its Medicaid program. That included a more stringent test for determining how people qualify.

"This is something that when we announced in January we said that there would be consequences and that it would signal the restructuring of the Medicaid program," Morgan said "When I say restructure the Medicaid program, it's the downsizing of the eligible populations to be served, and this is one of the most costly areas of Medicaid."

The average yearly cost of care for someone in a nursing facility is about $35,000, and the average cost of the home and community-based care is $5,000, Morgan said.

Being decertified means those people no longer qualify for Medicaid benefits to cover the cost of their care. They may, however, still be eligible for other Medicaid benefits.

While most decertified patients are appealing, they are allowed to remain where they are, Morgan told the Legislature's Medicaid Managed Care Oversight Advisory Committee.

A typical appeal process takes six to eight months, and Medicaid will continue to cover patients during that time, Morgan said. Patients are required to appeal their decertification within 10 days.

However, if they lose their appeals, either the patients or their families may wind up having to pay for their care, Morgan said.

"If these people are not successful in their appeals ... there is no guarantee of an absolute safety net," Morgan said. "Most of these people would have to use private pay, or their families would have to use private pay."

Most people decertified from living in nursing homes were diagnosed with Alzheimer's disease or dementia. They accounted for about 14 percent, followed by people with "chronic obstructive pulmonary disease" and hypertension.

Most decertified home and community-based patients suffered from arthritis, chronic obstructive pulmonary disease and mental illness.

There would likely be more patients decertified as the year goes on. However, administrators do not know for certain how many patients could later be deemed ineligible because a doctor must make a diagnosis on an individual's medical necessity, Morgan said. The number of nursing-facility residents decertified may grow to 450 by year's end, she said.

Kentucky AARP President Bill Harned said some of the people decertified may not be able to pay for their care themselves. He said the state should do more to help care for them.

"I have never before felt deeper concern and anguish for the people of Kentucky than I do now," Harned told the committee.