Budget uncertainty could make it harder for the elderly to access medical care

Cecilia Borbridge used a Miller Trust to afford the medical care she needed at the end of her life. (Photo/Borbridge Family)

Alan Borbridge and his sister cared for their mother at home for as long as possible. Cecilia Borbridge wanted to age at home. She came to Baranof Island as a teenager to attend Sheldon Jackson when it was still a high school. And she never left.

For the past ten-odd years, home and family care worked for the Borbridge family. But after a minor stroke earlier this year, Cecilia’s needs began to exceed Alan’s capacity.

“It was enough to where it became too much for me and my sister to manage on our own,” Borbridge said. “It was pretty obvious she needed 24/7 care.”

That meant finding a long-term care option for Cecilia, which wasn’t easy. That many elderly people struggle to secure and afford long-term care is nothing new. Governor Mike Dunleavy’s extensive budget vetoes threaten to make matters worse. Potential cuts to senior benefits and Medicaid have many concerned. But the elder community faces another potential setback – this one tied to cuts to the Alaska Legal Services Corporation.

The fate of the vetoes is currently uncertain: HB2001 restores much of the funding eliminated in Gov. Dunleavy’s line-item vetoes. That bill passed the House and Senate, but awaits the governor’s signature — or a second round of vetoes.

When Cecilia needed full-time, professional help. Alan and his sister turned to Sitka Pioneer Home in town. His mother required Tier III care at a cost of some $7,000 a month, Borbridge said. Despite being on a fixed income, Cecilia still made too much money each month to qualify for a Medicaid waiver that would defray the costs of care

Monthly payouts from her retirement fund put her “way over income” to qualify for that waiver Borbridge said. That’s because, depending on the specifics, Medicaid waivers or Medicaid is often the only way for low-income seniors to get support for long-term care, said Catherine Rogers, a member attorney at the Alaska Legal Services corporation.

Alongside other legal advice for low-income people, she spends a lot of her time helping elderly people afford medical care through something called a Miller Trust, or Qualified Income Trust. That’s what Rogers helped Alan set up for Cecilia. She also helped the Borbridge family manage their assets – another necessary step to qualify. The cuts to Alaska Legal Services could mean fewer people will have access to that support.

Without insurance through a Medicaid waiver, there was no way the Borbridge family could have afforded the Pioneer Home long-term. A Miller Trust changed that. They could funnel the quote-on-quote “extra” money that pushed Cecilia over the Medicaid limit into a special account. It’s a complicated, but essential, tool for the elderly community, Rogers says.

“Otherwise they cannot afford the healthcare that they need,” Rogers said.

But it isn’t a trust like any other: After a person passes, the state can tap the Miller Trust to reimburse itself for whatever it paid out for that person’s care through Medicaid. Rogers advised Alan to set up a Miller Trust for his mother. And it worked. She got into the Pioneer Home, where she lived for three months before passing.

“The way I look at it, it was a help-help for us and the state,” Borbridge said. “Everybody’s happy, everybody gets their money.”

A Miller Trust isn’t something that just anyone can walk into a bank to set up. It requires careful legal advice. Alan didn’t even know a Miller Trust was an option before he talked to Alaska Legal Services.

That legal advice might get harder to come by in Southeast Alaska, depending on whether or not Gov. Dunleavy signs HB2001. His vetoes from earlier this summer eliminated state funding for Alaska Legal Services. The House voted to restore that funding, but until the bill is signed into law, the future of legal aid remains in limbo.

Alaska Legal Services faces a loss of about $759,000, or a fifteen-percent of its budget. It might not sound catastrophic, but that money helps Alaska Legal Services operate in rural communities like Sitka, said Nikole Nelson, executive director of the organization.

Without the legal aid the organization provides, people might struggled to afford or access help with things like setting up trusts.

“People can lose their house, protections, or ability to access healthcare,” Nelson said.

Nelson says Alaska Legal Services expects to serve 1,393 fewer people statewide without state funding. Three offices will close. She doesn’t know yet which ones. And this elimination of funding is unprecedented. In the Alaska Legal Corporation’s 52-year life, it has always received a state appropriation.

“Since we’ve opened our doors,” Nelson said. “So this would be the first time.”

Rogers, the attorney in Sitka, says the threat of fewer services thanks to budget cuts leaves people like Borbridge at risk.

“These are people that are already on [the] cusp of not being able to afford things,” Rogers said. “Without someone doing this kind of work you leave vulnerable people unprotected.”

For the Borbridge family, the Miller Trust was make or break. Cecilia had savings, Alan says, but far from enough to consider a stay in the Pioneers Home without Medicaid and the Miller TrustAnd there’s no way Alan could have figured it all out on his own. 

“Minimum $150 or $200 an hour for an attorney, that’s really out of the question for a lot of people,” he said. “You don’t wake up in the morning and say ‘you know, I need to spend a few thousand on attorneys.’”

Alan lives on a fixed income. So without legal advice to help navigate the aging process, he, and many of the people in his community, are wondering where they’ll turn next.