Wednesday, December 1, 2010

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:

New Hampshire.
New Jersey.
North Dakota.
Rhode Island
South Dakota.
* Data for these states does not include certain LTC expenditures within managed care programs.

Steve Gold, The Disability Odyssey continues

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To contact Steve Gold directly, write to or call 215-627-7100.