State cuts hospice care

Terminally ill patients in Yuma County will have one less choice for end-of-life care after budget cuts to a state agency.

Medicaid patients will no longer receive hospice care through the Acute Care AHCCCS Hospice Benefit, through the Arizona Health Care Cost Containment System. The cuts to AHCCCS, the state Medicaid program, came with a 15 percent agencywide cut during a special legislative session in December.

Local hospice representatives say the cuts will limit options for people at the end of their lives.

From Nov. 1, 2008, through Oct. 21, 2009, Hospice of Yuma had 37 patients who received care through the program, said executive director John Williams.

"I know of two people that we've already had to turn down, which is absolutely heartbreaking to me."

Williams said people who don't have any health coverage could end up in the hospital - and the uninsured patients would help drive up the cost of health care through possible effects such as increased insurance premiums.

From a financial standpoint, it makes sense to keep the program, Williams said.

"Not only are we not saving the state money now, but we now have a group of people who have a limited group of options for the terminally ill," he said.

AHCCCS spokeswoman Monica Coury said not every single terminally ill patient would seek care from a hospital, that it depends on the individual.

She said AHCCCS does provide services for end-of-life care, though it wouldn't cover some services that hospice offers, such as pastoral counseling.

The cut to the program is part of a total $744 million in cuts to AHCCCS since the beginning of the downturn in the economy, she said.

The Yuma Sun previously reported other cuts to the agency, including a freeze on Kids Care enrollment, a state Medicaid program for children, and reductions in reimbursements for providers.

"These are all difficult decisions," Coury said. "It's not that we don't value hospice as a service, it's just the (economic) crisis.

"It is unfortunate."

Last year, Coury said, 541 patients statewide received hospice care through the program.

A second hospice provider in Yuma County, Hospice of Compassus, is a privately owned hospice with a nonprofit entity.

Executive director Amberly Hodgin said technically, they don't know the future of the program, "but we also know that there's a lot of push from people who are working on trying to make things right."

"Really, right now our hands are tied," Hodgin said. "We can't do much about it but just have to let things take its course and keep moving ahead."

One of the state legislators working on bringing back funding for the program is Sen. Amanda Aguirre, D-Yuma.

Aguirre said this is unfortunately one of the cuts that affected AHCCCS.

"This is not the way to save money to the state. That's not what we want for our taxpayers and our residents."

Aguirre said she and other legislators are working hard in a bipartisan way to provide the program to AHCCCS patients.

And while patients in larger metropolitan areas throughout the state may have more options, that's not the case in rural areas such as Yuma County, she said.

"Rural counties don't have that many choices so hospice is one of the choices to save money locally (and) to the local hospitals," Aguirre said.

Hodgin said up until this point, hospice was a completely reimbursable service, with private health care providers, Medicare and the state program.

Like Williams, Hodgin said the program saves money. "It's very beneficial and on top of that, people want to be at home."

And with donations down in many areas, the cuts from the state mean the nonprofit Hospice of Yuma and the nonprofit component of Hospice Compassus will have rely more heavily on charitable gifts to help offset the cost of end-of-life care for those who have no other health care.

"Hospice is such a wonderful service and such a needed service for everybody ...," Hodgin said, "because we can't turn them away if they're Hospice eligible.

"They deserve that care."