The Generations Project

1. The Generations Project Working to inform, educate, organize, and offer creative solutions to rebalance Indiana’s long term care system Established in 2001

2. AARP Indiana Alzheimer’s Association The Arc of Indiana Citizens Action Coalition of Indiana CICOA, Aging & In-Home Solutions COVOH - Council of Volunteers and Organizations for Hoosiers with Disabilities Indiana Alliance for Retired Americans Indiana Association of Area Agencies on Aging Mental Health Association in Indiana United Senior Action of Indiana. Collaborating Partners

3. The Issue • Rebalancing Indiana’s public spending for long term care: Medicaid • Balancing spending on home and community-based services with spending on institutional care. • Quality of Life Issue • Wise use of public money • Providing services that are preferred

4. Seniors Persons with disabilities Minorities Service Clubs Neighborhood & senior centers Labor & retirees Business organizations Academia Local Neighborhoods Faith-based organizations Critical Constituencies

5. Progress • Spring 2003: • Passage and signing into law of Senate Enrolled Act 493 • Spring 2004: • Little or no progress on behalf of state to implement the law. Delays, excuses.

6. Long Term Care Rebalancing Indiana’s Long Term Care System June Holt, Outreach Coordinator The Generations Project

7. Long Term Care • What is long term care? • Who needs long term care? • Where do people prefer to receive LTC? • Who pays for LTC? • Why should we be concerned about long term care?

8. Defining Long-Term Care • Long term care encompasses a broad range of help with daily activities that chronically disabled individuals need for a prolonged period of time • Primarily low-tech services • Assistance with ADLs and IADLs • Hands-on or supervisory human assistance • Assistive devices • Home modifications

9. Definitions What are they talking about? or Some terms you should know.

10. CHOICE Program • Community & Home Options to Institutional Care for the Elderly & Disabled • Totally funded by state of Indiana • Served 10,000 in 1999 • Model program for home care • HCBS = Home & Community Based Services

11. Medicaid Waivers • Allow Indiana to provide a variety of in-home and community-based services to individuals who would otherwise require the level of care provided in an institutional setting • Each client is assigned to a “waiver slot” • One can not receive services unless assigned to a waiver slot • Served 7,615 in FY 2002

12. Pays monthly benefits to the poor who are blind, disabled or elderly. 2003 SSI: $552/month for individual 300% SSI = $1656 Used as a qualifying amount for Medicaid services SSISupplemental Security Income

13. 2003 Senate Bill 493 A bill designed to rebalance the way Indiana spends Medicaid dollars on long term care. Passed without a negative vote by Indiana House and Senate Senate Enrolled Act 493: SEA 493 Signed into law in May 2003 Public Law 274-2003 IC 12-10-11.5 SEA 493:Long Term Care Reform Act

14. Institution or Home?

15. System is out of balance 2002 Medicaid funds • Indiana spent $1.1 billion on institutional care • Indiana spent $194 million for home and community based care • HCBC costs taxpayers 65-80% less than institutional care

16. Annual tax dollars in millions spent on long term care in Indiana (2001/2002) $1.174 billion $194 million

17. Indiana long term care costs

18. Balanced spending in other states

19. Hoosiers prefer home care • More than 27,000 on waiting lists for HCBC • Many qualify for NH bed but don’t want to go • Many empty nursing home beds • In 2001 nearly 25% of nursing homes were empty • #1 reason to get off waiting list is death • #2 reason is going into nursing home

20. Why has this happened? • Used to think NH or institutional care was best for the disabled – young or old • Laws written with “Institutional Bias” • Mandated NH/institutional care • These laws have created barriers for low income Hoosiers to receive HCBC • Laws force many into nursing homes who would be better served at home

21. SEA 493: The Law Rebalances the way public money (Medicaid) is spent on long term care

22. Eliminates barriers • Allows Medicaid dollars to follow the client from nursing homes to home care. • Makes the income eligibilitystandard for Medicaid home care services the same as for nursing home care at 300% of SSI. • Directs the state to apply for an additional 20,000 Medicaid waiver slots.

23. Supports families • Protects the spouse from becoming impoverished when services are provided at home. • Establishes a caretaker support program. • Expands services to include personal care services and more.

24. Respects the person • Expands client rights under Medicaid waivers. • Establishes the right to self-directed care. • Establishes a comprehensive array of home and community based services.

25. Provides for future needs • Indiana must establish a system of integrated services to facilitate Home and Community-based care including: • Improved transportation, • More choices in housing • Enhanced education • Expanded workforce development

26. Implementation of the Law • Indiana is slow in implementing this law • Waiting lists are too large and are growing • People are dying instead of getting the care they need and deserve.

27. 2004 Legislation • Passed Senate Bill 449 • Gives Health Finance Commission (Joint Senate & House committee) the charge to monitor implementation of SEA 493 • Will allow legislators to follow the implementation process of SEA 493

28. Opportunities for Hoosiers • Keep the issue alive until the law is working for us • Let the governor and your legislators know that you want this law to be implemented as quickly as possible • SEA 493 will save lives and save money

29. Questions, Discussion & Action Call the Governor at 317-232-4567 or E-mail at jkernan@state.in.us • Ask him to implement SEA 493, the Long Term Care Reform Act of 2003 • It’s good for taxpayers, it’s good for the state and it’s what Hoosiers want

30. Rebalancing Indiana’s Long-term Care SystemSEA 493: It’s the law! Thank You