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State of Medicaid Home and Community-Based Services

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%

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State of Medicaid Home and Community-Based Services

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  1. State of Medicaid Home and Community-Based Services Wendy Fox-Grage National Conference of State Legislatures

  2. 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)

  3. Budgets (con’t) • Other strategies • Using rainy day funds • Tapping other state funds • Delaying capital projects and cutting spending to balance their budgets

  4. 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

  5. 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.

  6. 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

  7. 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)

  8. Long-Term Care Planning • Planning • 42 state Olmstead task forces • Many of the 42 are writing plans that include all people with disabilities

  9. 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

  10. 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;

  11. 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

  12. 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 consumer-directed and/or offer maximum individual control; • Improvements in community long-term support

  13. 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)

  14. 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

  15. 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)

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