State by State Medical Assistance FY 2012 LTSS Data for Aged and Disabled. Information Bulletin #389 (May 2014) For the past eleven years, we have tracked Medicaid funds by State by comparing community versus institution expenditures for people with disabilities. The FY 2012 data is now available. This Information Bulletin will focus only on Older Adults and People with Physical Disabilities from both a six year (FY 2007-2012) perspective with a more detailed look at FY 2012. It was reported that “Federal Fiscal Year (FFY) 2012 marked the second consecutive year with little or no growth in national Medicaid spending for long-term services and supports (LTSS) [which includes both institutional and home and community-based services (HCBS)]… Average annual growth from FFY 2010 to FFY 2012 was 0.4 percent, compared to 6.2 percent from FFY 2000 to FFY 2010.” Some good news: the “total LTSS spent on home and community-based services (HCBS) increased from 48.7 percent in FFY 2011 to 49.5 percent in 2012. The shifting balance was attributable to both an increase in HCBS spending of 2.4 percent and a decrease in spending for institutional services of -2.3 percent.” However, this national average significantly “masks differences across population groups. HCBS accounted for 70 percent of spending in programs targeting people with developmental disabilities,” but only “39 percent of spending in programs targeting older people or people with physical disabilities.” That means for people with ID, only 30% of the entire MA LTSS went to institutionalize people, but for people with A/PD 61% went to nursing facilities. Yes, once again the ID advocates and ID community continues to spend a significantly higher percentage of their LTSS in the community and not institutions, as compared to the PD/A advocates. Focusing on the LTSS for people with physical disabilities, including aged people with disabilities [yes, the “aged” group is counted only if they have a disability that would qualify for nursing facility care], there is some encouraging data. 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 2012, it was 38.8% to 61.2%. 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 attack, the arc of history will continue to bend, but very, very slowly. We all know why this imbalance is so slow to change: the nursing home industry is very powerful and contributes a lot of money to Governors and State legislators, and they set your State budgets. 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 with an institutional bias. Unlike the for people with Developmental Disability, where 28 States spend more than 75% of their Medicaid expenditures in the community and only 3 States spend less than 50% in the community, for the Older Americans and People with Physical Disabilities no States spent more than 65% in the community and 48 spent less than 50% in the community. Quite a difference! Here are the States that spent the least in the community in FY 2012 for A/PD, and therefore spent the most in the nursing homes. The worst/least Medicaid expenditures in the community was North Dakota, followed by Kentucky, Alabama, New Jersey, South Dakota, Indiana, New Hampshire, Rhode Island – all spent less than 20% of their MA LTSS in the community for people with A/PD, and by definition therefore spent more than 80% in nursing homes. 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 five states spent more than 70% of the Medicaid funds in the community for people with DD, while spending less than 20% in the community for people with A/PD: New Hampshire, Alabama, Rhode Island, South Dakota and Kentucky. Quite a difference! Here are the States that spent the most in the community in FY 2012 for A/PD, and therefore spent the least in the nursing homes: Minnesota, Alaska, Washington, Oregon, California, District of Columbia, Texas and Wisconsin. These States are the winners – virtually the same as in 2011. What are advocates in these States doing right? Tell us. 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. 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 stevegoldada1@gmail.com or call 215-627-7100. Ext 227.