Wednesday, October 9, 2013
State by State Data for Aged and Disabled: Institutional Bias? Information Bulletin #383 (October 2013) For the past ten years, we have tracked Medicaid funds by State by comparing community versus institution expenditures for people with disabilities. The FY 2011 data is finally available. This Information Bulletin will focus only on Older Adults and People with Physical Disabilities from both a six year (FY 2006-2011) perspective with a more detailed look at FY 2011. The “good” news is that in FY 2006, the national average of community versus institutional Medicaid expenditures was 29.6% to the community and 70.4% to the nursing homes. In FY 2011, it was 38.1% to 61.9%. Yes, it’s a slow, incremental change. And yes, inherent in the lethargy and pace are people being discriminated against in violation of the ADA. Without a serious national litigation attack, the arc of history will continue to bend, but very slowly. The nursing home industry is very powerful and contributes a lot of money to State elected officials. Given that most people want to live in the community and not nursing homes, the quid pro quo is obvious. The nursing home industry “contributes” to your elected State officials, who in return continue to raise the per diem nursing home reimbursements and continue to allocate Medicaid funds in a discriminatory manner. Unlike the for people with Developmental Disability, where 23 States spend more than 80% of their Medicaid expenditures in the community and only 7 States spend less than 50% in the community, for the Older Americans and People with Physical Disabilities only 1 State spent more than 80% in the community and 44 spent less than 50% in the community. Quite a difference! Here are the States that spent the least in the community in FY 2011 for A/PD, and therefore spent the most in the nursing homes. The worst/least Medicaid expenditures in the community was Rhode Island, followed by North and South Dakotas, Alabama, Delaware, Kentucky, New Hampshire, Mississippi, Indiana, Utah, and Pennsylvania. Six of these “worst” A/PD states either have an exceptionally strong nursing home industry or the State elected officials have a particular dislike of Old Adults and People With Physical Disabilities. Compare their community-based Medicaid expenditures for people with Developmental Disabilities versus Older Adults and People with Physical Disabilities. The following six states spent more than 72% of the Medicaid funds in the community for people with DD, while spending less than 22% in the community for people with A/PD: Alabama, Kentucky, Delaware, New Hampshire, Utah, and Pennsylvania. Quite a difference! Here are the States that spent the most in the community in FY 2011 for A/PD, and therefore spent the least in the nursing homes. New Mexico was far and away the best, followed by Minnesota, Washington, Alaska, Oregon, California, Texas and Wisconsin. These States are the winners. Advocates for Older Adults and people with Physical Disabilities should sit down in your State with the advocates for people with Developmental Disabilities to discuss their successful strategies. Advocates should ask their attorneys why they are not banging down the courthouse doors with lawsuits under the ADA and Olmstead. 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. Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to firstname.lastname@example.org or call 215-627-7100. Ext 227.