Wednesday, January 30, 2013

The Disability Community and Medicaid Expansion: What’s At Stake. Information Bulletin #369 (1/2013). In 2010 Congress enacted the Affordable Care Act. One part of this legislation mandated that all States expand their Medicaid to all persons whose incomes are under 138% of the federal poverty level, which is less than $15,415 per year for a single person and less than $31,809 for a family of four. In June 2012, the U.S. Supreme Court held that Medicaid Expansion could not be a mandate, making Medicaid Expansion optional for States. This Fact Sheet explains why Medicaid Expansion is vitally important to people with disabilities. Based on data from the 2010 American Community Survey for people under 65 years old, 13.7% of non-elderly community residents with family incomes under 138% FPL have disabilities, compared to 6.7% of those with incomes above that level. So the disability rate among poor or near-poor Americans is more than twice that of those with higher incomes. For people with disabilities on SSI, they already receive Medicaid. Also, in many States that provide Medicaid Waivers for community-based services for people with disabilities, the income eligibility levels are above SSI. However, there are a LOT of people with disabilities in every State who are neither on SSI nor on a Waiver and who do not have any health coverage for basic health care – doctors, prescriptions, and hospitalizations. These are the people with disabilities for whom Medicaid Expansion is critical! What follows are the number of people by State who are at 138% of the federal poverty level and under, who are not currently receiving Medicaid, either based on SSI or Waiver, and are under 65 years. While a majority of States are opting into the Medicaid Expansion, a number have not yet decided it is in their economic interest or the interest of people with disabilities. [We also have separate Fact Sheet for the recalcitrant States. It makes an economic development argument why the States should participate. If you want it for your State, just email me with the name of your State.] Disability Advocates - here are the number of people with disabilities who will benefit if your State Expands Medicaid eligibility! # People with Disabilities under 138% FPL, under 65, and not currently on Medicaid Alabama 77685 Alaska 6550 Arizona 37366 Arkansas 44130 California 227747 Colorado 35162 Connecticut 16640 Delaware 5269 District of Columbia 3774 Florida 190073 Georgia 105420 Hawaii 5623 Idaho 16118 Illinois 80884 Indiana 67339 Iowa 19183 Kansas 24259 Kentucky 76619 Louisiana 67078 Maine 12465 Maryland 31616 Massachusetts 19008 Michigan 109828 Minnesota 24521 Mississippi 51235 Missouri 67885 Montana 10475 Nebraska 13643 Nevada 21158 New Hampshire 10237 New Jersey 41611 New Mexico 20393 New York 102793 North Carolina 105627 North Dakota 3453 Ohio 121348 Oklahoma 49336 Oregon 49213 Pennslyvania 108012 Rhode Island 10213 South Carolina 60840 South Dakota 5878 Tennessee 80742 Texas 237253 Utah 12641 Vermont 3383 Virginia 59705 Washington 49436 West Virginia 34953 Wisconsin 31285 Wyoming 4197 0 U.S. 2665407 Steve Gold, The Disability Odyssey continues Thanks to Steve Kaye, UCSF Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at with a searchable Archive at this site divided into different subjects. Information Bulletins will also be posted on my blog located at To contact Steve Gold directly, write to or call 215-627-7100. Ext 227.

Friday, January 11, 2013

Nursing Home Residents and My Medicaid Matters. Information Bulletin #368 (1/2013) Over the next year, States may try to reduce community-based Medicaid-funded services for both disabled and elderly people. When they do, advocates should instead force them to focus money going to the institutional Medicaid-funded services, i.e., nursing homes, the flip side to the community. Nursing homes, unlike the community, continue to receive increased Medicaid reimbursements. People who have “self-care” needs, i.e., who need assistance with activities of daily living, trigger both an ADA/Olmstead and a fiscal issue, depending on where they receive these Medicaid services – in the community or in an institution. Based on data collected and analyzed by Steve Kaye, Director, PAS Center, UCSF, advocates can use the following points in your State’s My Medicaid Matters struggle to show how to reduce institutional expenses. The point of the data is to enable advocates to ask why your State has so many non-elderly and non-cognitively impaired persons unnecessarily institutionalized. What follows are ratios of two specific subcategories of nursing home residents (1. non-elderly and 2. non-cognitively impaired) to the total state population with self-care difficulties in 2010. First, nationally, there was an average of 6.3 non-elderly nursing home residents per 100 non-elderly people with self-care difficulties. The ten worst States with much higher rates than 6.3 national average are ranked as follows: Illinois (#1 with 14.5 non-elderly N.H. residents), Connecticut (#2 with 12.2), North Dakota (#3 with 11.7), District of Columbia (#4 with 11.3), South Dakota (#5, 10.1), and then Ohio, Iowa, New York, Hawaii, and Missouri. Why do some States have twice the national average of non-elderly persons with disabilities institutionalized? With appropriate scope and quantity of community-based services, many of these non-elderly people could and would want to live in the community. Many States have addressed this and significantly reduced non-elderly persons in nursing homes – e.g., New Mexico has 2.8 non-elderly NH residents per 100 total NH residents, less than 25% of the worst State. The number of non-elderly persons in NH is a matter of State policy. What is your State doing to reduce this institutionalized population? Rather than reduce community-based services, reduce much more expensive NH residents and provide services in the community. Second, nationally, there was an average 7.5 nursing home residents (all ages) without cognitive impairments per 100 with self-care difficulties. The ten worst States with high rates well-higher than the national average are ranked as follows: North Dakota (#1 with 23.4 N.H. residents), Iowa (#2 with 17.0), South Dakota (#3 with 16.4), Connecticut (#4 with 16.2), Rhode Island (#5, 15.3) and then Nebraska, Kansas, Wyoming, Indiana, and Minnesota. States have addressed this and many have reduced this institutionalized population including, e.g., Oregon with only 3.1 non-cognitively impaired NH residents per 100 population with self-care difficulties, less than 13% of the worse State. Others include Alaska (2.3) and Arizona (4.3). Here’s another unnecessarily institutionalized group who should be addressed before community-based reductions are implemented. Third, States which have “rapidly rebalanced” their state Long-Term Care Medicaid expenditures, i.e., shifted more than 10% of their Medicaid funds from institutional care to community-based care, have reduced the total number of long-stay nursing residents by 9% between 2002 and 2010. In States that have not rapidly rebalanced their LTC budgets, there has been an increase in nursing home residents. Advocates must know what’s happening on the institutional side of the ledger. Look at the institutional expenditures over the past eight years. Has the N.H. per diem increased? Compare it to the community-based services. Are there people in N.H. who could be more inexpensively served in the community? Has the total N.H. population increased or decreased? The NH industry is a powerful player, but we have the data and the way to save money. If your State is threatening to reduce community-based Medicaid Long-Term Care services, use these three items to argue why such reductions are wrong. Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at with a searchable Archive at this site divided into different subjects. Information Bulletins will also be posted on my blog located at To contact Steve Gold directly, write to or call 215-627-7100. Ext 227.