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.


  1. I'm feeling pretty bold here. I believe that there may be a small word missing from the second sentence of your blog entry. I believe that this sentence should read, "When they do, advocates should instead force them to focus ON money going to the institutional Medicaid-funded services, i.e., nursing homes, the flip side to the community." It is a subtle, yet important semantic difference which I believe was intended.

  2. Articles and content in this section of the website are really amazing. Great ideas indeed! I will surely keep this in my mind!

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