Thank you for the story “Oz questions Medicaid Spending.” I am glad to hear that the CMS is cracking down on Medicaid Fraud, Waste and Abuse in New York State. Apparently, our Medicaid Spending is much higher than it is in other states, mostly because of home health programs. I want to share my experience with this.

From 2011-2014, I worked as an HHA/PCA for the NHTD/TBI program through a home health agency in the Hudson Valley. This is part of Medicaid’s Home and Community Based services. NHTD stands for Nursing Home Transition and Diversion Waiver and is for people who would otherwise qualify to live in a nursing home but can live in the community with support. TBI stands for Traumatic Brain Injury and is the same model for people with TBIs. This program was a way to cut back on the costs of institutional care, and shift care into the community.

A daytime aide comes from 7am to 7pm. Then, a night aide comes from 7 pm to 7 am. The patient was not to be left alone. Aides had to stay until someone came to relieve them. If you left your case, you could be charged with abandonment.

For the most part, this worked out. Usually, someone did come to relieve me. But there was always this anxiety, of never really knowing if someone would show up or not, call out sick, etc. Every day, when 7 pm or 7 am rolled around, I’d anxiously await the ring of a doorbell or footsteps approaching.

And if there was a big storm, it wasn’t uncommon for aides to get stuck on a case for days on end before someone could come to relieve them. I once got stuck on Christmas for 36 hours.

I was always anxious, too. At any given moment, my supervisor could call me and send me somewhere to cover a case.

At night, there wasn’t much to do, except be there in case the client needed anything. Some aides just worked night shifts and would just go crash on someone’s couch 6-7 nights per week and make a living off that.

Starting pay was $13/hr in 2011. But there was no overtime pay. I knew aides who worked over 100 hours per week just to make ends meet, with no reimbursement for gas mileage. I remember frequently being sent to cases far away with no reimbursement for mileage.

It created a staffing nightmare. One client kept a tally and said that she had over 70 aides come in and out of her house. Other clients also expressed similar frustration with so many different aides coming in and out.

Most cases had about 3-4 regular aides who were that person’s main caregivers. But filling in the gaps was hard. Staffing wasn’t always consistent.

I think that things are different now. The company has made some changes and cleaned things up a bit, and there is overtime, too.

I am concerned about the BBB and the government’s cuts to Medicaid, especially in our state's rural areas. I don’t want people to be denied care who truly need it. But when I look back at my years covering the NHTD/TBI cases, I must wonder about the efficacy of programs like this.

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