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Ohio’s Unified Long-term Care Budget

Ohio’s Unified Long-term Care Budget Building a Cost-Effective, Consumer Friendly Long-term Services & Supports System Purpose To develop a comprehensive, flexible and transparent process for effective and efficient budgeting and service delivery that:

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Ohio’s Unified Long-term Care Budget

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  1. Ohio’s Unified Long-term Care Budget Building a Cost-Effective, Consumer Friendly Long-term Services & Supports System

  2. Purpose • To develop a comprehensive, flexible and transparent process for effective and efficient budgeting and service delivery that: • Encompasses both facility-based and home- and community-based long-term services and supports • Is based on consumer choice and differing levels of service need • Includes a seamless array of service delivery options • Features a consolidated policymaking and budget authority to simplify decision making and maximize the state’s flexibility Ohio Department of Aging

  3. Desired Outcomes - Consumers • Consumers will be satisfied with the services they receive and experience a higher quality of life. • Ohioans will be encouraged to plan ahead for future service and support needs, as well as be better prepared to make informed decisions about their options. Ohio Department of Aging

  4. Desired Outcomes - System • A transparent budget for policymakers. • A cost-effective system that links disparate services across agencies and jurisdictions. • Consistency in provider rate-setting. • Accurate expenditure forecasts. Ohio Department of Aging

  5. Promoting Flexible Funding to Support Long Term Living Presentation courtesy ofSusan C. Reinhard, DirectorAARP Public Policy Institute

  6. Balancing LTC = Achieving more “parity” in funding community and institutional options so consumers have more “real choice”. Set of Balancing Strategies, including increasing community capacity, informing people of options, funding/budgeting, nurse delegation and workforce, etc. Key Concepts Ohio Department of Aging

  7. Financing • Money Follows the Person = financing for services and supports moves with the person to the most appropriate and preferred setting. • Global budgeting • Texas MFP • Deficit Reduction Omnibus Reconciliation Act • Rebalancing (Balancing) = reduced reliance on institutional options, increased community options. Ohio Department of Aging

  8. Coherent Systems Management Access Comprehensive information, simplified eligibility, and single access points PERSON Philosophy of self-direction and individual control in legislation, policies, and practices Community Life Financing A seamless funding system supporting individual choice Services Responsive supports across settings and provider types Quality Improvement Comprehensive systems that assure quality of life and services Key Building Blocks Ohio Department of Aging

  9. Money Follows the Person (MFP) Planned Parity Global Budget (Pooled Financing; Unified Budget) Budget Strategies Ohio Department of Aging

  10. Money Follows the Person = financing for services and supports moves with the person to the most appropriate and preferred setting Commonly starts from nursing home to HCBS--State example is Texas Useful when long HCBS waiting lists and low occupancy in nursing homes MFP Strategy Ohio Department of Aging

  11. Can be separate LTC budgets (nursing home, HCBS); mandates reductions in nursing home budget and transfer of those savings to fund HCBS Aggressive policy and program actions required (universal screening, level of care criteria, pre-admission processes, etc.) Examples--Maine, Vermont in 1990s Planned Parity Strategy Ohio Department of Aging

  12. Vermont Act 160 • Shifted funds from nursing home to the HCBS appropriation • Goal 60-40% institution/community • Strategies: NF moratorium, expand residential alternatives, one time investments • Five percent drop in NF supply Ohio Department of Aging

  13. Act 160 • “The reductions required … shall be redirected in FY 1997 to fund home and community-based services. For fiscal year 1998 and thereafter, the reductions required ... shall be redirected … to fund both home and community-based services and any programs designed to reduce the number of nursing home beds. • Any general funds redirected but not spent during any fiscal year shall be transferred to the long-term care special administration fund...” Department of Aging and IndependentLiving Services Ohio Department of Aging

  14. Vermont 1115 Waiver • Provide maximum choice of services and settings • Eliminate institutional bias • Promote early intervention • Break link between 1915 (c) waivers and NF level of care Ohio Department of Aging

  15. Global Budget • Consolidating all of the components of long term care spending into a single state agency budget • Funding can follow the person as they move between services • Placing the nursing facility, HCBS and state-funded personal care programs and budgets into a single division Ohio Department of Aging

  16. Global Budgeting • Global Budgeting provides a budget appropriation format that allows LTC dollars to be used in the most cost-effective manner Ohio Department of Aging

  17. Global Budget • Set a total LTC spending budget based on • projected LTC needs and preferences • planned policy and program initiatives • Provide full administrative freedom to manage costs within the spending limit to respond quickly to consumer preferences Ohio Department of Aging

  18. Washington: A Pioneer • Legislature set forth philosophy • ….establish a balanced range of health, social and supportive services that deliver long term care services to chronically, functionally disabled persons of all ages and to ensure that services are provided in the most independent living situation consistent with individual needs” (Revised Code of Washington (RCW) §74.39.005) and “to the extent of available funding, the department shall expand cost effective options for home and community services for consumers” (RCW, 74.39A.030). Ohio Department of Aging

  19. New Jersey Strategy • Budget and Policy Consolidation at state level for older adults • Create more choices for HCBS services • Help consumers find choices easily through single entry point (NJ EASE) and Community Choice Counseling (nursing home transition) Ohio Department of Aging

  20. Patrick Flood, VT DAILS Ohio Department of Aging

  21. Washington Success: LTC Spending Trends Based on data from the Washington Aging and Disability Services Administration Ohio Department of Aging

  22. WA: Shifting spending balance Ohio Department of Aging

  23. New Jersey Success • 3,500 fewer Medicaid beneficiaries in nursing homes • 10.4 % reduction in census, surpasses almost all states in recent years Ohio Department of Aging

  24. Ohio Department of Aging Source: NJDHSS, Sept 15, 2004 Trenton, NJ

  25. Indicators of Success in Colorado • Reduced the rate of growth in LTC spending • Saved 17% over projected LTC budget in 1994 • Served 21% fewer in nursing facilities than projected • (Lewin Group study) • In 1996, began serving more clients in HCBS than in nursing facilities (cross-over point) • Milne, 2005 Ohio Department of Aging

  26. Indicators of Success in Colorado • Spent 51.1% of LTC budget on HCBS in 2001 • Ranked 5th in US • Profiles of LTC-2002, AARP • Spent 32.7% of Elderly/Disabled LTC budget on HCBS • Ranked 8th in US in 2003 • Milne, 2005 Ohio Department of Aging

  27. Critical Elements to Support Transformation • Vision, Mission • Leadership and Partnerships • Access to multiple financing sources (Medicaid HCBS & state plan, OAA, state general revenues) • Streamlined financial and functional eligibility • Comprehensive/single entry point • Strong quality management system, including information systems Ohio Department of Aging

  28. The Changing Face of Long-Term Care: Ohio’s Experience 1993-2005 Presentation courtesy ofRobert Applebaum Scripps Gerontology CenterMiami University

  29. Ohio Fast Facts… • The population in Ohio who are most likely to need long-term care (those over age 85) has increased by 55,000 (38%) over the last 12 years (1993-2005). • Despite the population increase the number of nursing home beds in service has been reduced from a high of 99,000 in 1997 to about 94,000 in 2005. • By 2050, there will be one million Ohioans over age 85. • By 2020, Ohio will have more than 220,000 older people with severe disabilities, almost 26% more than 2005. • The number of residential care facility beds has increased from 8,700 in 1993 to about 43,000 in 2005. Ohio Department of Aging

  30. Estimated Proportion of Ohio's Population with Severe Disability in Different Settings Ohio Department of Aging

  31. Ohio Medicaid 2005 • Ohio spent $11.5 billion on Medicaid. • Medicaid was 24% of Ohio’s annual budget. • 42% of Ohio’s total Medicaid budget was spent on long-term care. • Ohio spent $2.6 billion on Medicaid nursing homes (ranks 9th) $1 billion on Medicaid ICF/MR facilities (ranks 5th). • Ohio spent $950 million on Home and Community Based Care Waivers (ranks 26th). • Ohio ranked 47th in home care/nursing home expenditure ratio. Ohio Department of Aging

  32. $140,000 $123K $120,000 $99K $100,000 $80,000 $64K $54K $60,000 $44K $40,000 $22K $21,372 $12K $20,000 $10K $8K $2,491 $0 NF ABD CFC ODADAS PASSPORT Home Care MR Waiver Mental Health ICF/MR Public ICF/MR Private ABD Community Average Annual Cost per Person FY 2005, Includes Medicaid Card Costs Ohio Department of Aging

  33. Ohio Nursing Facility Admissions1992-2005 Ohio Department of Aging

  34. Short-Term Stay… More than 56% of all those admitted to nursing homes: • are no longer residents after 3 months • almost 7 in 10 are no longer residents after 6 months • by year end only one out of every 6 still there Ohio Department of Aging

  35. Proportion of Total & Medicaid Nursing Home Residents Still Living in a Facility Ohio Department of Aging

  36. Nursing Home Utilization in Ohio1993-2005 Ohio Department of Aging

  37. Average Daily Nursing Home Census1993 to 2005 Ohio Department of Aging

  38. Demographics of Residents in Ohio’s Certified Nursing Facilities: June 2004 (%) Ohio Department of Aging

  39. PASSPORT Usage Ohio Department of Aging

  40. Functional Characteristics of Ohio’s PASSPORT Consumers: 2004 (%) Ohio Department of Aging

  41. Distribution of Ohio’s Medicaid LTC Utilization by Setting: 1993-2005 Ohio Department of Aging

  42. Number of Older Persons* Using Nursing Facilities or PASSPORT Services * Per 1,000 persons over age 60 in the population Ohio Department of Aging

  43. Process & Decisions

  44. The Process • The Governor will appoint a workgroup. • Legislative leadership will appoint four members of the General Assembly. • The plan is to be completed by June 1, 2008, and must be submitted to the Joint Committee on Medicaid Technology and Reform. • Seven subcommittees, building on existing efforts, will assist the workgroup. Ohio Department of Aging

  45. Decision Roadmap • Who will be served by the long-term services and supports budget? • What does “long-term services and supports” include? Ohio Department of Aging

  46. Questions for theSubcommittees

  47. “Front Door” Subcommittee • What will be the design of the “front door” to long-term services and supports? Ohio Department of Aging

  48. Care Management Subcommittee • What is the role of care management? • Who benefits from care management? • How will we interface with Medicare Special Needs Plans? Ohio Department of Aging

  49. Quality Subcommittee • How will we incorporate the CMS “quality framework” into all aspects of long-term services and supports, including nursing facilities? Ohio Department of Aging

  50. “Unmet Needs” Subcommittee • What unmet needs currently exist and what additional long-term services and supports should Ohio offer? Ohio Department of Aging

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