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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