Help Your State Save Medicaid Funds and Comply with the ADA.

Help Your State Save Medicaid Funds and Comply with the ADA. Information Bulletin # 326 (12/2010)

Twenty-four states in FY 2009 spent less than 25% of their Medicaid Long Term Care expenditures for home and community-based services. Yes, these twenty-four states in FY 2009 spent more than 75% of their Medicaid Long Term Care expenditures on nursing homes! [The list is below.]

Looked at another way, ten years after the Supreme Court in Olmstead declared unnecessary institutionalization in nursing homes as discrimination under the ADA, these twenty four states’ Medicaid expenditures are still significantly biased toward nursing homes.

In the last Information Bulletin, “Are you ready for a real fight?” we discussed all the publicity and outcries about Medicaid expenditures. We reminded advocates for elderly and disabled people that it was significantly cost effective to provide services in the community, instead of paying nursing homes.

We know the reason for the continued institutional bias – the nursing home industry contributes a lot of money to your Governors and state legislators. These political contributions are not acts of charity, but are the quid pro quo to keep the nursing home industry supplied with Medicaid cash cows - elderly and disabled people.

Isn’t it time to point out to the press, friendly legislators and other advocates your state’s hypocrisy -- complaining about Medicaid costs while at the same time refusing to reduce nursing home Medicaid expenditures by providing services in the community?

When Congress enacted the Affordable Care Act of 2010 (at section 10202), it offered these 24 states the opportunity to receive an increased Federal Medical Assistance Percentage (FMAP) of five percentage points if your state rebalances its LTC to be less institutionally biased. [There were another twenty-one states that spent between 25 % and less than 50% of their Medicad LTC on community-based services. If these states rebalance, they will receive an additional two percentage FMAP points.]

That’s five additional percentage points on what your State spends on its HSBC programs and services. We’re talking a lot of additional money from those five points!

Does your Governor want to increase the community-based expenditures by five percentage points for basically complying with the ADA? It’ll cost no additional money - just rebalancing the budget.

Under Section 10202 of the ACA of 2010, if your Governor is really serious about saving Medicaid funds, he/she must submit a plan to the U.S. Department of Health and Human Services, and describe how the state will rebalance its program to increase its community-based expenditures and to decrease its nursing home expenditures. Let’s hope HHS really holds the States to a high standard.

This increased FMAP does require a state to have: (1) a single entry point so that before a person goes into a nursing home, the person is really offered the choice of community-based services; (2) an assessment instrument used state-wide to determine what services a person needs to live in the community; and (3) case management services that are conflict free. One might think that these three would already exist in every state, but obviously they do not.

Okay. That’s what your Governor has to do to increase federal Medicaid funds. Now the issue is whether or not your Governor will submit a plan. Write letters to the newspaper posing the question. Telephone supportive legislators. Find out if your state will submit a plan.

Here are the 24 States that in FY 2009 expended less than 25% of their Medicaid LTC on community-based services and, therefore, conversely spent more than 75% on nursing homes:

Alabama
Arizona*
Connecticut.
Delaware
Florida.
Hawaii*
Illinois
Indiana
Kentucky
Maine.
Maryland
Michigan
Mississippi
Nebraska
New Hampshire.
New Jersey.
North Dakota.
Ohio
Pennsylvania
Rhode Island
South Dakota.
Tennessee*
Utah
Wyoming
* Data for these states does not include certain LTC expenditures within managed care programs.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com
with a searchable Archive at this site divided into different subjects.
As of August, 2010, Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

Are you ready for a real fight?

Are you ready for a real fight? Information Bulletin # 325 (11/2010)

Anyone notice the number of articles announcing “Ending Medicaid”? A number of Governors, with Texas’ Rick Perry in the lead, huff and puff that their states will withdraw from Medicaid. It’s been reported that the “soaring cost of Medicaid” was a prime issue at the recent Republican Governors Association meeting. Add these Governors and “Ending Medicaid” takes on a life of its own.

The threats run the gamut from (a) entirely dropping out of Medicaid to (b) wanting to block grant Medicaid to (c) avoiding all federal requirements to (d) eliminating or significantly reducing Medicaid’s “optional” programs

Let’s remember that Medicaid includes and reimburses many institutional forces. What will hospitals that received $63 billion in Medicaid payments in FY 2009 do? Not treat and turn away patients? What about the $71.6 billion in Medicaid Managed Care Premiums? Managed Care companies are big contributors to Governors and state legislators. How about Medicaid’s $50 billion to the nursing home industry?

Okay. So the threat of ending Medicaid is really only a first salvo for Governors to attack Medicaid and especially “optional” Medicaid services.

For older people and people who are disabled, advocates had better be worried at a state level, because the Medicaid services people need to live in the community are those classified as “optional,” i.e., they are not mandatory under Medicaid.

Optional Medicaid services include all Waivers, Personal Care, drugs/medications, mental health, targeted case management – many of the services people need to stay out of nursing homes and Intermediate Care Facilities. Medicaid mandatory services include nursing homes and ICFs.

No question that since the Olmstead decision, Medicaid’s Home and Community-Based Services have increased significantly, and no doubt your Governor will target them, especially since HCBS are not as politically well connected as the nursing home industry.

Nevertheless, advocates should remember, organize around and point out the following

First, compliance with the Americans with Disability Act is not “optional.” As long as your state provides institutional services in nursing homes and ICFs, your state must also provide services “in the most integrated setting” – a person’s home or apartment. Moreover, as the Centers for Medicare and Medicaid Services has written, compliance with Medicaid is not the same as compliance with the ADA. Both must be complied with, and the only way to comply with the ADA is with adequate and appropriate services in the community.

Don’t let your state get around the ADA by reducing HCBS reimbursements so that no one will work at low wages. Don’t let them reduce the number of personal assistance service hours so people must go into an institution. Don’t let them keep a shell without any meaningful contents,

Second, under the ADA, a State cannot condition receipt of an optional service (for example, medications) on a person going into an institution to receive those services, instead of receiving the exact same services in the community. The United States Department of Justice has written a number of briefs supporting this.

Third, nationally, nursing homes and ICFs are a much higher percentage of Medicaid’s long-term care than community-based services. (You must know the data for your State.)

Also, remember that when the Supreme Court issued its Olmstead decision, the institutions received a far, far disproportionate allocation of Medicaid’s LTC than community-based services received. In the past 11 years, we have been trying albeit too slowly to rebalance a system that in 1999 was extremely institutionalized and blatantly segregated people in these institutions. So of course HCBS has increased a lot since Olmstead.

Fourth, nursing homes and ICFs in most states still receive a far larger percentage of the LTC than community-based services. Therefore, when talking about “reductions,” make sure that the institutions are the primary focus of reductions, especially when so many people in them do not want to live there and could reside in the community. Otherwise, we will be back to 1999.

Fifth, it is far cheaper to provide services in the community than in institutions. There is data galore. If your Governors are so interested in saving Medicaid funds, go after the expensive Medicaid expenditures – to nursing homes and ICFs – not to the less expensive services in the community. There will be people for whom it may be more expensive in the community, but they are a small minority.

Sixth, no one ever said this Odyssey would be easy or smooth. The draconian threat to end of Medicaid is not at the federal level, but at the individual state level. Reduction of “optional” Medicaid services is also only at the state level. Therefore, state advocates for older people and people with disabilities had better be strategically positioned TOGETHER for the 2011 struggles.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com

with a searchable Archive at this site divided into different subjects.

As of August, 2010, Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/

To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

HCBS Reductions? What Advocates Can Do.

HCBS Reductions? What Advocates Can Do. Information Bulletin # 324 (9/2010).

Has your State threatened to cut back or reduce Medicaid-funded home and community-based services ? Has your State actually reduced HCBS Medicaid services? What impact will these reductions have on people remaining in the community?

What can advocates do about these reductions? What should CMS do?

In addition to how the ADA and integration will be impacted if the reductions are implemented, another handle is the Medicaid statute itself?

To receive federal Medicaid funds, a State must have a written state plan that has been submitted to and approved by the Secretary of the U.S. Dept of Health and Human Services. CMS posts state MA plans and amendments at www.cms.gov/medicaid/stateplans/

State MA plans must be amended to reflect changes in federal policy, Court decisions, and “material changes” in policy, state law, or operation of the program. 42 Code of Federal Regulations § 430.12. Proposed State plan amendments must be submitted to the CMS regional office which must “consult with central office staff on questions regarding application of Federal policy.” 42 C.F.R § 430.14. CMS must make a “determination as to whether State plans (including plan amendments and administrative practice under the plans) originally meet or continue to meet the requirements for approval are based on relevant Federal statutes [including the ADA] and regulations.” 42 C.F.R § 430.15.

Hmmm. The United States Supreme Court in 1999 in the Olmstead decision found that unnecessary segregation in institutions violated the ADA - sure sounds like a Court decision. CMS has issued several “Dear State Medicaid Director” letters telling states that their State plans must comply with both the Medicaid and the ADA statutes, and these letters sure look like federal policy.
Therefore, when your State proposes reductions in HCBS, advocates must analyze what impact the reductions will have on causing or preventing unnecessary segregation. Advocates must ensure that CMS will disapprove the amendments based on Olmstead and its own policy requiring compliance with the ADA.

Advocates for older and younger Americans with disabilities should:

1. Find out if your Governor has reviewed the proposed amendments, a Medicaid requirement for State plan amendments?
2. Contact your regional CMS officials and obtain copies of documents between your State and CMS regarding the amendment.
3. Unbelievably, there is no requirement for public hearing or even an opportunity for public comment. Nevertheless, each State has a Medical Care Advisory Committee that reviews and comments on proposed changes. Get to them and make your voices heard.
4. Send your comments to the CMS regional office AND to the Secretary of HHS. Tell them how the amendments will impact on people unnecessarily being institutionalized.

Thanks very much to the National Health Law Program for their invaluable suggestions and observations, many of which are the basis for and incorporated in this Information Bulletin.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com
with a searchable Archive at this site divided into different subjects.
As of August, 2010, Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

Rebalancing MA FY09 - How Is Your State Doing?

Rebalancing Medicaid’s Long-Term Care Expenditures: How Is Your State Doing? Information Bulletin #323 (9/2010).

In the Affordable Health Care Act in 2010, Congress provided that States would receive an increased federal match IF they “rebalance” their Medicaid expenditures from institutional expenditures to community expenditures. This was Section 10202 - “Incentives for States to Offer Home and Community-Based Services as a Long-Term Care Alternative to Nursing Homes”. States that spend less than 25% on community service could receive a 5% enhanced match and states that spend less than 50% could receive a 2% enhanced match.

In this Information Bulletin, we focus on why this section is important and how best it should be implemented to get the funding to the most states and to the states most out of balance regarding institutional and HCBS community spending.

Last Bulletin highlighted how well the DD Community has done in most states to reverse the institutional bias in Medicaid spending in relationship to the aging and physical disability community. Section 10202 could be used to make both the NF and ICF-MR funding streams more community based in states with the most inequitable systems.

Rebalancing of Medicaid’s long-term care expenditures is critical for older and younger people with disabilities eligible for nursing home services as well as persons with developmental disabilities. If your State shifts expenditures from the more expensive nursing home budget to the less expensive community budget, there will be more Medicaid funds available to serve more people in the community. By offering a larger federal match to move money from nursing homes to the community (HCBS), there will be a financial incentive for states to confront the lobby of the nursing home industry and increase funding for community services (HCBS).

This would be an opportunity for advocates in aging and disability organizations to join together to push for this new HCBS opportunity that begins October 1, 2011.

We decided to look at how state expenditures were made in FY 2009. Remember the Supreme Court ruled in Olmstead in 1999 over 10 years ago.

We use the state data compiled by Thompson Rueters under CMS contract. www.hcbs.org/browse.php/sby/Date/source/150/ThomsonReuters

From that data, we computed what follows.

Here’s what all the terminology and acronyms mean for this bulletin:

1. Long-term care (LTC) is the total Nursing Home (NH) and

Home and Community-Based Services (HCBS) spending;

2. Institutional is the total Nursing Home spending;

3. Home and Community-Based Services includes the total of Medicaid Waivers, Home Health and Personal Care Option spending.

Here’s what we found:

1. The Overall Picture -

In 2009, 66.2% went to NH and 33.8% went to HCBS.

While percentages are important we should also look at funds spent. In 2009, over $50 billion went to NH and over $25.5 billion went for HCBS.

2. A State Breakdown

In 2009, there were only four States that definitely spent less than 50% of A/D on nursing home institutions [WA, MN, OR, and Alaska]. These four therefore spent more than 50% of their LTC funds in the community for HCBS. It is likely that NM and CA are also in this category, but neither has reported all of its data for 2009. [In DD, only 6 states in FY 2009 spent less than 50% in community! Wow – absolutely opposite the A/D world.]

In 2009, there were 23 States that spent more than 75% of their Medicaid LTC A/D on nursing homes.[NE, ME, CT, OH, WY, AL*, MI, NJ, AZ, FL, UT, HI*, IL*, KY, PA, NH, IN, MS, MD, SD, DE, ND, RI*]. *All data not reported. These 23 States have not “rebalanced” their A/D expenditures and 10 years after Olmstead still are overwhelminingly institutionalized biased.

While the field as a whole is moving in the correct direction by increasing spending in the community for HCBS, these 23 states still lag far behind in overall HCBS expenditures.

Conclusion:

According to the FY 2009 data gathered for the above analysis 44-46 states would be eligible to apply for the 2% enhanced match offered in the Section 10202 HCBS Rebalancing language IF CMS makes the policy decision to have the percentages based on these funding streams.

23 states would be eligible to apply for the 5% enhanced match offered in Section 10202 HCBS Rebalancing language if CMS makes the policy decision to have the percentages based on funding streams.

If the policy goal of Congress was to “Rebalance” the LTC system, using Section 10202 to focus on the states with the most inequitable funding patterns, seems like a simple CMS policy decision to focus on those States with the most egregious unbalanced LTC services.

Tell Cynthia Mann, CMS Medicaid Director this is what you would like to see happen. (Cynthia.mann@cms.hhs.gov)

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com

with a searchable Archive at this site divided into different subjects.

As of August, 2010, Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/

To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

Comparing Olmstead Implementation Among Disabilities. I

Comparing Olmstead Implementation Among Disabilities. Information Bulletin #322 (9/2010).

For years, we have reviewed and compared Medicaid expenditures for people in institutions and in the community. For quite a number of these years, advocates for people who have an Intellectual/Developmental Disabilities have consistently used the Medicaid’s Home and Community-Based systems far better than advocates for older and younger people with physical disabilities, dementia.

To analyze how well the Olmstead's ADA mandate to end unnecessary institutionalization of people with disabilities has been accomplished, it is necessary to separate these two groups, ID/DD (previously MR/DD) vs. A/D(Aged/Disabled) (these are CMS designations). The reason this is necessary is, because depending on the disability label people have affixed to their heads, this label determines the institution into which you may be unnecessarily institutionalized and the funding stream you can access in the community.

Under the federal Medicaid statute, people with a ID/DD label are institutionalized in State Centers and ICF-MR (Intermediate Care Facilities for Mentally Retarded), and older and younger people with, for example, physical disabilities, dementia or anything other than the ID/DD label, are unnecessarily institutionalized in nursing homes.

These institutions, though similar in how they treat people, differ dramatically when measured by per person spending which carries over directly into the Medicaid Home and Community-based Waiver system and therefore into the amount and package of services a person will receive. Therefore, the label triggers the institution which triggers the amount of Medicaid community-based services one receives.

This long-winded explanation is necessary to understand that when one compares Medicaid community vs. institutional expenditures, the label determines both the institutional and community-based expenditures.

With this background information, we can now compare Olmstead's ADA mandate by looking at the Medicaid expenditures for the two groups. Here's what we find:

* In FY 2004, nationally the distribution of Medicaid Long Term Care expenditures for MR/DD services spent 42.4% in the institutions (State Centers and ICF-MRs) and 57.6% of the total LTC in the community. In dollars, $12 billion went to MR/DD institutions and $16 billion for services in the community.

* In the same year, FY 2004, nationally the distribution of MA LTC expenditures for A/D services spent 74.9% institutions (nursing homes) and 25.1% in the community. In dollars, $46 billion went to A/D institutions and $15 billion for services in the community.

Let's see what changes occurred in five years. Was there a leveling and how much progress was made?

* In FY 2009, nationally the distribution of Medicaid Long Term Care Expenditures for ID/DD services spent 34.4% in the institutions (State Centers and ICF-MRs) and 65.6% in the community. In dollars, $13 billion went to MR/DD institutions and $26 billion for services in the community.

* In FY 2009, nationally the distribution of expenditures for A/D services spent 66.2% institutions (nursing homes) and 33.81% in the community. In dollars, $50 billion went to A/G institutions and $26 billion for services in the community.

The FY2004 data and statistics were only five years after the Olmstead decision. However, the FY 2009 data is ten years after Olmstead. Though there has been a lot of improvement, there is still a significant institutional bias if one has the A/D label.

Let's compare the two funding groups over the five years:

The good news is that between 2004 and 2009, both groups had increased the distribution of Medicaid expenditures in the community as compared to their respective institutions.

But the inexplicable fact remains: people with a ID/DD label have a significantly better chance of residing in the community than people with an A/D label.

Just the facts!

There were 17 States in FY 2009 that expended more than 80% of their Medicaid funds inthe community for people with ID/DD. Congratulations!
There were only 2 States in FY 2009 that expended more than 60% (that's correct) of their Medicaid funds for people with A/D in the community! Wow.

Here are a few examples: Why in FY 2009 would Michigan spend 99.2% of Medicaid funds for people with ID/DD in the community but only 21.5% in the community for people with A/D? Similarly, New Hampshire spent 98.1% for ID/DD in the community but only 17.7% in the community for A/D; Alabama spent 87.8% for ID/DD in the community but only 14.9% for A/D in the community.

Why are there such marked differences based on a label?

Are the ID/DD advocates better than the A/D advocates?

Do younger and older people with physical disabilities prefer nursing homes over community services?

Why can State administrators (Medicaid Directors) continue to shift Medicaid funds from ID/DD institutions to the community while at the same time increase significantly faster the pace of shifting the A/D Medicaid funds to the community?

If the goal is to rebalance the entire long-term service and support system, then we need to look at how each of the funding streams are faring and develop rebalancing strategies to meet our overall goal of a total community integrated system.

Disability advocates - whether older or younger are people with disabilities. Whether your label is A/D or ID/DD or MI or....... , we all want services in the most integrated setting. The Olmstead decision was about all of us. Isn't it about time we confront the labels and the different funding streams?

The people united will never be defeated. El pueblo unido jamás será vencido!

Thanks to Thompson/Reuters for compiling the above state MA expenditures data.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com
with a searchable Archive at this site divided into different subjects.
As of August, 2010, Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

FY 2009 Institution vs Community-Based Medicaid Services for Older and Younger Americans with Disabilities,

FY 2009 Institution vs Community-Based Medicaid Services for Older and Younger Americans with Disabilities, Information Bulletin #321 (8/2010)

Each State’s FY 2009 Medicaid expenditures provide extremely helpful information to analyze your State’s distribution of its Long Term Care expenditures between its Institutional versus Community-Based Services.

Follow the Medicaid money and you’ll see how committed your State really is to ending unnecessary institutionalization of older and younger Americans with disabilities. How your state allocates its expenditures demonstrates its commitment to provide the elderly and younger persons with disabilities a real choice between unnecessary institutionalization and living in the community.

Let’s repeat - “show us the money” and where your state spends it, and you can see how much your state respects both the ADA and the Olmstead decision. Remember that the Supreme Court in 1999 - more than ten years ago -told states to end unnecessary institutionalization! The FY 2009 data was just released by Thomson Reuters, an independent contractor which compiles the data submitted by each State to the federal funding agency. Thanks very much.

How much progress has been made? Let’s compare the past five years.

In FY 2004, States spent 74.9% of their total Medicaid LTC funds for “Aged/Disabled” [i.e., older and younger Americans with disabilities] Services in nursing homes, and 25.1% in the community.

In FY 2009, States spent 66.2% of their total Medicaid LTC funds for “Aged/Disabled” Services in nursing homes, and 33.8% in the community.

In dollar terms, in FY 2004, States spent about $46 billion on institutional care and $15 billion in the community.

In FY 2009, States spent about $50 billion on institutional care and $26 billion in the community

The good news is that there was an 8% shift towards the community in those five years. The bad news is that ten years after the Olmstead decision, States are still spending nearly twice the amount of Medicaid LTC funds on nursing homes than on services in the community, despite the overwhelming survey data showing that people want to stay at home.

There is nothing magical about where your State allocates its Medicaid money. Tomorrow States could turn the FY 2009 upside down and spend 66.2% in the community instead of in nursing homes - IF States wanted to do so. Congress and CMS has given States enormous flexibility during the past five years but most States have not taken advantage of the options.

Why has the change been so slow? State legislatures and Governors seem to be very beholden to the nursing home industry, which definitely knows how to play the political process much better than elderly and disabled advocates.

Until the political pressure from the people with disabilities - regardless of age- increases, the nursing home industry will prevail.

Let’s look at how your State did in FY 2009 with its Medicaid Long-Term Care expenditures for older and younger Americans with Disabilities:

Some States have consistently done very poorly and have been consistently below the national average. Some States conversely been consistently above the national average.

Some States seem ripe for class action Olmstead litigation.

What sanctions are CMS and OCR planning for those States that have both lengthy waiting lists for community-based services and spend disproportionately on nursing homes?

% nursing % community
homes
National .....................66.2% ............ 33.8%

Alabama .....................85.1% ............14.9%
Alaska ....................... 44.3% ............55.7%
Arizona ..................... 78.6%............21.4% *
Arkansas.................... 71.0 ............29.0
California...................44.9 ............55.1*
Colorado.................... 56.4............43.6
Connecticut................75.7............24.3
Delaware....................87.5............12.5
D. C............................54.4............45.6
Florida........................79.5............20.5
Georgia.......................74.0............26.0
Hawaii........................80.8...........19.2*
Idaho...........................56.7............43.3
Illinois.........................80.2 ............19.8
Indiana........................83.8 ............16.2
Iowa............................70.4 ............29.6
Kansas........................60.6............39.4
Kentucky....................80.7 .............19.3
Louisiana....................67.5............32.5
Maine..........................75.5 ............24.5
Maryland.................... 85.1...........14.9
Massachus.................. 64.1............35.9*
Michigan.....................78.5............21.5
Minnesota...................42.5............57.5*
Mississippi..................84.2............15.8
Missouri......................66.3 ............33.7
Montana......................66.1............33.9
Nebraska.....................75.1............24.9
Nevada........................65.9 ............34.1
New Hampshire..........82.3............17.7
New Jersey.................78.8............21.2
New Mexico...............31.2...........68.8
New York ..................61.9...........38.1*
North Carolina............57.2............42.8
North Dakota.............. 89.8............10.2
Ohio............................75.9 ............24.1
Oklahoma................... 67.6............32.4
Oregon....................... 43.8............56.2
Pennsylvania............... 82.1............17.9
Rhode Island............... 95.6............4.4*
South Carolina............ 72.1...........27.9
South Dakota.............. 86.0...........14.0
Tennessee................... 91.1..........8.9*
Texas......................... 55.5..........44.5*
Utah............................80.4............19.6
Vermont.....................67.5............32.5*
Virginia.......................64.9..........35.1
Washington ................38.0 ...........62.0
West Virginia.............. 74.5.............25.5
Wisconsin .................. 74.0 ............ 26.0*
Wyoming ...................76.6............23.4

* Data may not include certain LTC expenditures with managed care or 115 waiver data not available.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com
with a searchable Archive at this site divided into different subjects.
As of August, 2010, Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

Older Americans and People with Disabilities - Bridging the Disconnect.

Older Americans and People with Disabilities - Bridging the Disconnect. Information Bulletin # 320 (8/2010)

This Information Bulletin is an attempt to bridge and solidify advocates from two communities - older Americans and people with disabilities. For many reasons, there has been a disconnect between them.

More than two years ago, we wrote “The Older Americans Act: Consumer Choice and Control over Long Term Care,” (see February 9, 2007 Information Bulletin). We reviewed how Congress’ amendments to the Older Americans Act and its “Choices for Independence” began to provide services for people to remain in their homes, instead of going into nursing homes. The Older Americans Act was for the first time really focused on community!

The OAA provided grants for States to develop a “single point of entry” for long-term care, so people would know what community-based services were available in order to avoid institutionalization. This single point was through the “Aging and Disability Resource Centers” (ADRC). It also adopted the “consumer model” so people could self-direct care and services.

The Older Americans Act is up for reauthorization in 2011. Yes folks, Congress will have to face whether or not the “Aging and Disability” centers will be refunded. This reauthorization will provide a forum and opportunity for these two communities to discuss how well they have worked together, how well the ADRCs are functioning, if they are serving both older Americans with disabilities and younger Americans with disabilities and what changes should occur.

There are a number of issues which we hope both communities understand and address:

1. Medicaid is the same funding stream for long-term community care and nursing homes for all people with disabilities, regardless of age. Cut-backs and reductions of Medicaid services impact every disabled person, and State legislatures’ common attacks on services will hurt people regardless of age.

2. Yes, these two communities do not agree on everything (e.g., assisted living, identifying oneself as having a disability), but there are unequivocally common interests. In an era of reductions and attacks by States on community-based services, it is critical to put aside differences and join to fight what the two communities have in common.

3. There really is power in numbers! Can you imagine a State legislative hearing with twenty-five year old wheelchair uses holding hands with seventy-five year old wheelchair uses demanding their right to live in the community and not being dumped into nursing homes.

4. How about next year, during the Congressional reauthorization hearings, joining forces? Tell Congress that all people with disabilities, regardless of age, want the right to receive services in their own homes.

5. The increased Medicaid funds for Money Follows the Person grants must focus on getting anyone out of nursing homes who wants to live in the community - not just people with disabilities under 60 years old. Older Americans do not enter nursing homes because they want to; they do not have community-based services offered to them. If both communities combined their efforts, they could have a significant impact of enhancing waivers - especially in those 20 States that have not yet received MFP grants but probably will be applying for them very soon.

6. The Independent Living Centers serve many older Americans with disabilities. Yet, the AAAs and ILCs in most states keep each other at some distance. As the under 60s younger Americans with disabilities become the over 60s older Americans with disabilities, yes it really happens, the disability issues and culture will cross the age barrier. Let’s hope that the people take the lead and make these organization really work together.

To not take the 2011 reauthorization as an opportunity to address these issues and to jointly work out strategies is perilous.

POWER concedes nothing without a struggle.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com
with a searchable Archive at this site divided into different subjects. To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.




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