[Paleopsych] WSJ: Another Tough Issue Schiavo Case: Brings Forth: Who Pays for Care?

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Another Tough Issue Schiavo Case: Brings Forth: Who Pays for Care?
By SARAH LUECK 
Staff Reporter of THE WALL STREET JOURNAL
March 24, 2005; Page A4

The emotional debate over Terri Schiavo's medical treatment has
eclipsed a much smaller but related public-policy issue related to her
case: Who pays the bills for those unable to care -- or pay -- for
themselves.

It is an issue that divides Ms. Schiavo's husband, who wants her to be
permitted to die, and her parents, who want her kept alive. It is also
a flashpoint between those who want to reduce the government's
health-care spending, particularly in Medicaid, and those who defend
it.

For at least two years, the hospice caring for Ms. Schiavo has covered
most costs, said Deborah Bushnell, an attorney who represents Ms.
Schiavo's husband, Michael. Medicaid, the federal-state program for
the poor and disabled, covers Ms. Schiavo's prescription medications.

Ms. Schiavo, who has severe brain damage, also is eligible for
Medicare. The federal program provides health coverage to people who
are disabled for more than two years. But The Hospice of the Florida
Suncoast, the Largo, Fla.-based parent corporation of the facility
where Ms. Schiavo resides, made an "internal decision" not to bill the
government programs for her care, Ms. Bushnell said.

In part, the hospice was responding to Ms. Schiavo's parents, Bob and
Mary Schindler, who objected to their daughter being on government
assistance, Ms. Bushnell said. The parents said a medical-malpractice
settlement of more than $1 million that Mr. Schiavo received should be
used for her medical care, not spent on legal fees in the court battle
over whether Ms. Schiavo should be kept alive.

An attorney for the Schindlers didn't return a request to comment.
Louise Cleary, a spokeswoman for the hospice, said she couldn't
comment on a specific patient, citing privacy rules. She said the
hospice, a nonprofit corporation with several facilities, provided
$9.5 million worth of free care to 1,800 patients in the fiscal year
ended Sept. 30.

Under Medicaid, Ms. Schiavo receives painkillers for cramps and
medications associated with feeding tubes, Ms. Bushnell said. The
monthly cost "probably doesn't exceed a couple hundred dollars," she
said. Ms. Schiavo is in Florida Medicaid's "medically needy" program,
Ms. Bushnell said. The program, which covers about 35,000 people in
the state, is for people with high health costs who don't meet the
usual Medicaid income requirements.

Ms. Schiavo's attorneys set up what is called a special-needs trust to
help her qualify for Medicaid. The trusts, permitted under federal
law, allow disabled people under age 65 to qualify for Medicaid even
if their assets exceed the normal limits. After death of the patient,
the state can recoup Medicaid costs from the trust.

In recent years, as Florida has faced budget problems, the medically
needy program has been targeted for cutbacks at various times by
lawmakers and Gov. Jeb Bush. In March, Gov. Bush proposed restoring
funding to the program. Both Gov. Bush and his brother President Bush
have said Medicaid rules allowing people to transfer or hide assets
ought to be more restrictive, though they haven't commented publicly
on the type of trust Ms. Schiavo has.

If the Schindlers prevail in the court appeal and Ms. Schiavo's
feeding tube is replaced, she could stay alive for many years. The
hospice, when deciding to pay most of Ms. Schiavo's bills, "thought it
was going to be short term," Ms. Bushnell said. If Ms. Schiavo's
feeding tube is hooked up again, donated care is unlikely, she said.
"She's going to be on the government dole," Ms. Bushnell said.

Write to Sarah Lueck at sarah.lueck at wsj.com7

http://online.wsj.com/article/0,,SB111162674657988316,00.html