Transcript Slide 1

On the Verge:
The Transformation of Long-Term
Services and Supports
7/21/2015
www.nasuad.org
Funded by AARP under direction of
the Public Policy Institute
Built on 6 prior NASUAD state surveys
Final Report
9/27/2010
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Research Methodology
E-Survey to 50 states, DC, and 4 territories
Medicaid Agencies and State Units
on Aging
Targeted programs for aged and
physically disabled
Follow up telephone interviews
Response: 48 states and DC
22 from both Medicaid and
State Unit on Aging Agencies
23 State Units on
Aging only
3 Medicaid only
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Primary Findings
State LTSS
Transformations
• States on the verge of transforming the financing and delivery
of LTSS
• Many plan to or have implemented Medicaid Managed LTSS
Budget Cuts and
Increased
Demand
• States using administrative tools at their disposal to curtail
expenditures
• Increased demand due to economic downturn
Staffing Changes
and Reductions
• With 26 new governors in office in 2011, record number of new
state officials
• Staff reductions top the list of savings strategies for nonMedicaid/ Provider reimbursement for Medicaid
Uncertainty of The
Affordable Care
Act (ACA)
• Litigation pending before the U.S. Supreme Court
• Many states are reluctant to commit to ACA programs
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Budget Context
States Continue to Struggle through Tough
Economy
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Recession Remains a
Significant Factor
Major General Fund revenue sources
(PI, Corp, and Sales Tax) below prerecession levels for most states
28 states still project 2012 tax revenues below
2007 pre-recession levels
22 states are now projecting collections above
2007 levels
While revenues are down, states
must contend with increasing
service demand
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Percent Change in State Tax Revenue
2007 (actual) to 2012 (projected)
Personal Income, Corporate, and Property Taxes
WA
MT
NH
VT
ND
ME
MA
MN
OR
ID
SD
WI
NY
MI
WY
PA
IA
NE
NV
UT
IL
CO
CA
IN
OH
MO
SC
MS
TX
AL
GA
Percent Change
-25.7% to -15%
LA
-14.9% to -10%
FL
AK
MD
NC
TN
AR
NM
VA
KY
OK
NJ
DE
WV
KS
AZ
RI
CT
-9.9% to -5.0%
-4.9% to - 0.1%
0% to 9.9%
HI
10%+
Source: HMA analysis of data from National Association of State Budget Officers (NASBO), Spring Fiscal Survey of States, 2007-2010 reports , and Fall 2011
Report for 2012 Notes: 2012 figures are enacted. For Illinois, this map uses projected revenue from NASBO’s 2006 report because 2007 data was not available.
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DRAFT: NOT FOR
DISTRIBUTION
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Aging and Disability Programs
Impact of the Recession on non-Medicaid funded
LTSS
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Reductions in non-Medicaid State Aging and
Disabilities Agency Budgets, State Fiscal Years 09-12
Source: AARP, HMA, NASUAD Economic Survey, FY 10, FY11. FY09 data is from NASUA Economic Survey, December 2009.
SFY 2012 Non-Medicaid State Aging and
Disabilities Agency Budget Actions
Current and Planned Savings Strategies, State Fiscal Years 2011 – 2012
Programs with Increased Service Demands, State Fiscal Year 2011
Decreased Service Expenditure for Non-Medicaid Programs, SFY 10-11 and 11-12
Medicaid
Impact of the Recession on Medicaid funded
LTSS
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States are Transforming LTSS Delivery and
Finance
Increased interest in Medicaid Managed LTSS
•
•
•
•
12 states with existing programs
11 states plans to implement in 2012 or 2013
Half plan to implement statewide
About 2/3 have or will require mandatory enrollment – but
half of these will allow an opt out
Increased focus on Dual Eligible service integration
• 28 states report efforts to integrate Medicare and
Medicaid services for “duals”
Plans for HCBS Waivers Consolidation
• 15 states considering for administrative and
programmatic simplification
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U.S. Medicaid Enrollment Increases
in Economic Downturns
Aged and Disabled enrollment largely
unaffected by economic fluctuations, but….
Enrollment
increase in other
groups creates
fiscal stress
may prompt
states to curtail
LTSS optional
services
Enrollment increases likely
contribute to LTSS policy decisions
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U.S. Medicaid enrollment growth shows signs of slowing
Annual growth rate
FY 1998-FY 2012
(projected)
Source: “Moving Ahead Amid Fiscal Challenges: A Look at Medicaid Spending, Coverage and Policy Trends: Results from a 50-State
Medicaid Budget Survey for State Fiscal Years 2011 and 2012;” Vernon K. Smith, Kathleen Gifford, Eileen Ellis, et.al.; Kaiser Commission on
Medicaid and the Uninsured; October 2011. Note: Enrollment percentage changes from June to June of each year.
Loss of federal ARRA FMAP results in 24% increase in
State Medicaid funding in FY 2012
Annual Growth in Total and State
Medicaid Spending, 2000–2012
Total
State General Fund
23.7%
0.23
ARRA Enhanced FMAP
(2009-2011)
0.18
0.13
0.08
12.7% 12.9%
10.1%
10.4% 9.9%
8.7% 8.4%
8.5%
7.7%
5.5%
7.6%
6.4%
4.9%
0.03
7.3%
6.6%
5.8% 5.7%
4.0%
3.8%
3.0%
2.2%
1.3%
-0.02
Enhanced FMAP / Federal
Fiscal Relief (2003-2005)
-0.07
-0.12
10.3%
2000
2001
2002
2003
2004
2005
-4.9%
2006
2007
2008
-10.9%
2009
2010
2011
2012
Adopted
Source: “Moving Ahead Amid Fiscal Challenges: A Look at Medicaid Spending, Coverage and Policy Trends;” Vernon K. Smith,
Kathleen Gifford, Eileen Ellis, et.al.; Kaiser Commission on Medicaid and the Uninsured; October 2011. NOTE: State Fiscal Years.
Nearly half of states have or are planning Medicaid
Managed Long Term Care Programs
WA
MT
NH
VT
ND
ME
MA
MN
OR
ID
SD
WI
NY
MI
WY
PA
IA
NE
NV
UT
IL
CO
CA
IN
OH
MO
SC
MS
TX
AL
GA
Percent Change
Existing Program
(in 2010 or 2011)
LA
FL
AK
MD
NC
TN
AR
NM
VA
KY
OK
NJ
DE
WV
KS
AZ
RI
CT
Plan to Implement
in 2012
Plan to Implement
in 2013
HI
Most States have or plan statewide implementation
Most states have either voluntary enrollment or mandatory
with opt out option
- However, 6 require enrollment with no opt out
States indicate a strong interest in integrating
services for people enrolled in Medicare and
Medicaid (“Duals”) in their MMLTC programs
Most states increased HCBS waiver
expenditures in 2011
Percentage Range of Increases in HCBS Expenditures
2010 to 2011
12
Number of States
10
8
6
10
9
4
6
2
2
0
Less than 5%
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5%-8%
8-15%
More than 15%
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Most states also increased the number of
individuals served through HCBS waivers…
Changes in HCBS Caseload From Previous Year
27
2011
3
7
Increased
Decreased
31
2012
Stayed the same
0
6
0
10
20
30
40
Number of States
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….while Medicaid nursing facility census
is expected to decrease or remain static
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Affordable Care Act
Many states report uncertainty about pursuing
provisions within the Affordable Care Act
because of pending litigation in the U.S.
Supreme Court as well as a lack of final federal
guidance on implementation.
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States’ Indication of Intent to Pursue
Selected Affordable Care Act Options
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State Outlook
What to expect in 2012
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State Long-Term Services and
Supports Priorities
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Conclusion
LTSS Transformations
• The sluggish economy and increased demand for
publicly-funded LTSS are putting pressure on state
policymakers to redefine the way LTSS are financed
and delivered
State Officials
• Many state officials are new to their jobs and many
state agencies have less staff due to staff reductions
Reforms
• Many service delivery systems changes are still
unfolding. Concern about Congressional budget
actions and ACA guidance.
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