Proponents of Proposal 4 maintain that it will save the taxpayers money. However, even the proponents acknowledge that these savings arise from providing home care rather than institutionalizing the care recipients in nursing homes or assisted care facilities.

Nothing in the proposal makes a shift of Medicaid recipients out of nursing homes more likely than it is now. The Home Help Program to assist with home care has been underway for more than three decades. No provision in Proposal 4 would increase the payments made to the recipients for their care or for paying caregivers, so there would be no new economic incentive to provide new in-home services.

Nor does Proposal 4’s establishment of the MQHCC seem likely to increase outreach to in-home care candidates who might otherwise be relegated to institutional care. A DCH audit of the Home Help Program found that in fiscal years 2002, 2003 and 2004 — the period just prior to and including the early months of the MQC3 — the Home Help Program had 51,372, 53,812 and 55,382 care recipients, respectively.[72] A 2011 report by Anderson Economic Group indicated, however, “In 2010, the average monthly number of Home Help consumers was 53,516” — if anything, a slight decline.[73] The MQHCC is a successor to the MQC3 in mission and scope, so it appears no more likely than the MQC3 to affect the ratio of institutionalized and home-based care recipients.