Transcript State Long-Term Care: Recent Developments & Policies

State of Medicaid Home and
Community-Based Services
Wendy Fox-Grage
National Conference of State Legislatures
State Budget Shortfalls
• 33 states estimate budget gaps in excess of
5%, with 18 of those facing gaps above
10%
• 37 states say spending is exceeding
budgeted levels, with all but five reporting
excessive Medicaid or health care costs
• 29 states have imposed across-the-board
budget cuts (Source: NCSL)
Budgets (con’t)
• Other strategies
– Using rainy day funds
– Tapping other state funds
– Delaying capital projects and cutting spending
to balance their budgets
Medicaid Challenges
• Medicaid spending grew by more than 13%
between 2001 and 2002, the fastest rate of
growth since 1992 (Source: NASBO)
• Focus on containing Medicaid costs rather
than expanding services
• State long-term care/Olmstead plans call for
expansions to meet consumer demand for
HCBS
Medicaid (con’t)
• Only 1 out of 4 Medicaid enrollees are
elderly and disabled
• They account for 2/3 of spending. Per capita
expenses: $11K for elderly, $10K for
disabled, $1900 for adults; $1200 for kids
(Source: Urban Institute)
• Large impact of cost increases due to
greater need among these groups for Rx,
NH, etc.
Medicaid (con’t)
• Over past two years, virtually every state
took actions to slow the rate of increase in
Medicaid expenditures
• Changing policies for Rx drugs was most
common strategy
Medicaid (con’t)
• Freezing or reducing some provider payment rates
(probably used in ¾ of states)
• Benefit reductions or eligibility changes (used in
as many as 30 states)
• 36 state Medicaid programs reported receiving
supplemental appropriations in 2002 and report
similar situations for 2003 (Source: HMA survey
for Kaiser)
Long-Term Care Planning
• Planning
– 42 state Olmstead task forces
– Many of the 42 are writing plans that include
all people with disabilities
Olmstead Plans
• Some states developed specific strategies slated
for implementation over a # of years,
• Some identified key priorities for more immediate
actions,
• Some set forth broad policy recommendations to
guide future action,
• Others anticipate frequent plan updates and
revisions in what they consider to be working
documents
Olmstead Plan Recommendations
• Helping people make the transition from
institutions into the community;
• Promoting affordable and accessible housing;
• Improving the recruitment and retention of direct
care workers;
• Providing information and referral as well as
family-centered assessments;
• Allowing funding to follow the individual rather
than the providers;
Olmstead Plan Recommendations
(con’t)
• Reducing the waiting lists for HCBS;
• Increasing employment opportunities for people
with disabilities;
• Enhancing data collection activities and systems;
• Improving transportation that complies with the
ADA requirements; and
• Assuring quality of care based on outcomes
Funding Strategies
• Using existing state agency budgets and
federal systems change grants
• CMS awarded millions of dollars in new
grants in 2001 and 2002 to 48 states
– Nursing home transition grants
– Personal assistance services that are consumerdirected and/or offer maximum individual
control;
– Improvements in community long-term support
2002 Legislation
• Olmstead-related commissions: CA, DE, NH,
NM, NY, OK, VT and VA
• Consumer direction: CO, FL and ME allowing
consumers to hire their own family members and
friends to provide long-term care services using
government funds
• Information, referral and assessment: FL (211
network); MD (NH residents to receive one-page
info sheet on HCBS); MS (Single point of entry)
Big Picture: The Long-Term Care
System
• From medical/institutional to social model
• Home and community-based services
• Empowering consumers and allowing them
to use public funds in the most integrated
setting
–
–
–
–
Consumer demand
Money
Court decisions
Federal government
Big Picture: What Does the
Future Hold?
• Home and community-based services
• Quality of care in nursing homes and assisted
living
• Consumer direction
• Consumer assessment, information and outreach:
reliance on family caregivers
• States looking at no cost or low cost solutions
given budget crises (stretching existing agency
budgets)