Olmstead 15th Anniversary [Part Two] - How Much Progress Has Your State Made? Information Bulletin # 391 (6/2014). In the previous Information Bulletin, Olmstead 15th Anniversary [Part One] - How Much Progress Has Your State Made? we provided a State-by-State breakdown of Medicaid Long Term Services and Supports for both institutional expenditures and community-based Medicaid expenditures, comparing Fiscal Years 2000 and 2012. In this Information Bulletin, we will look at the biggest institution for people with disabilities – nursing homes. The 2000 census reports that there were 1,720,500 persons of all ages with disabilities residing in nursing homes. [Remember, “aged” people must be disabled in order to receive Medicaid reimbursement for nursing home care; they do not qualify based on age alone.] How much progress have we made? By March 31, 2013, the number had been reduced to 1,414,957 – an 18% reduction in the population of institutionalized disabled people. [See Chart One below for a State-by-State breakdown.] June 22, 2014 is the Fifteenth Anniversary of the Supreme Court’s Olmstead decision. In accordance with that decision and with the ADA’s “most integrated setting” requirement, people with disabilities should free from being unnecessarily isolated or at risk of unnecessary isolation in nursing homes. While there has been an 18% reduction in the nursing home population of people with disabilities nationwide, rates vary among the States. Hawaii had a 28% increase and Nevada had a 4% increase in nursing home population from 2000 to 2013; however, these were the only two states that increased their institutional populations. A few States had small reductions of less than by 5% (Georgia had only a 1% reduction and Maryland had only a 5% reduction, which was followed closely by Texas and New Jersey’s reductions at 7% and 9% respectively. On the positive side, Oregon was the most effective State at reducing its nursing home population with a reduction of 47%, second was Alaska at 36% and the following States all reduced these populations by at least 30% (Idaho, Maine, Minnesota, Oklahoma, Vermont, D.C., and Wisconsin). Kudos to those States. While we do not have current comparison data for average Nursing Home occupancy rates, we do have it for 2011, when the national average occupancy rate was 83%. One might think that a State that had low nursing home occupancy rates would also be reducing its Medicaid expenditures on nursing homes. After all, it seems that reduced numbers of persons with disabilities in the nursing homes and many unused/unoccupied nursing home beds should result in less total Medicaid funds going to keep people with disabilities unnecessarily isolated or at risk of such isolation. [See Chart Two below.] Are you surprised to learn that between 2000 and 2012 there was a 31% increase in the total amount of Medicaid funding for nursing home residents? There was a $12.4 billion increase in Medicaid funding for nursing homes during those years despite both an 18% reduction in number of residents and only an 83% occupancy rate. [See Charts Three and Four below.] Sometimes I know I am in the wrong business. What is amazing given these reductions and relatively low occupancy rates between 2000 and 2012 is that the national average of Medicaid nursing home expenditures actually increased by 31%! There was a total of $12.4 billion more Medicaid expenditures over that period. Here are the States that increased their Medicaid nursing home expenditures by more than 80%: Arizona, Arkansas, California, Idaho, Indiana, Maryland, Mississippi, Nevada, Utah, Virginia. Although Delaware, Michigan and D.C. had less than a 10% increase, there were a few States that acutally reduced the percentage of their nursing home expenditures, including Hawaii, Minnesota, New Mexico, Pennsylvania, and Tennessee. It is hard to believe that the community of disability advocates cannot make the cost savings argument to your State legislatures and your Governors. We can and must make arguments newspapers, TV, and social media outlets that will result in real outrage. We know that more than 90% of aged and younger people with disabilities do not want to be institutionalized and would prefer to reside in their own homes and communities. We also know that it is cost effective to provide these services in the community and that they have actually been provided for people exactly like those residing in nursing homes. This is a shame. So what’s happening? The nursing home industry is ripping off your State budgets. (In the next Information Bulletin, we’ll discuss what’s going on in those nursing homes.) Here are four State-by-State Charts: the first is the decrease in nursing home populations from 2000 – 2013, the second is the nursing home occupancy rates in 2011, the third is the % increase in nursing home Medicaid expenditures between 2000 and 2012, and the fourth is the actual Medicaid dollar increase in nursing home expenditures between 2000 and 2012. Chart One - % decrease in nursing home populations from 2000 – 2013. Alabama -1-13% Alaska -36% Arizona -8% Arkansas -16% California -12% Colorado -10% Connecticut -21% Delaware -10% Florida -14% Georgia -1% Hawaii 28% Idaho -30% Illinois -18% Indiana -18% Iowa -24% Kansas -26% Kentucky -20% Louisiana -18% Maine -31% Maryland -5% Massachusetts -23% Michigan -18% Minnesota -32% Mississippi -12% Missouri -21% Montana -26% Nebraska -24% Nevada 4% New Hampshire -25% New Jersey -9% New Mexico -12% New York -12% North Carolina -25% North Dakota -21% Ohio -15% Oklahoma -32% Oregon -47% Pennsylvania -28% Rhode Island -11% South Carolina -18% South Dakota -18% Tennessee -17% Texas -7% Utah -16% Vermont -31% Virginia -24% Washington -24% DC -30% West Virginia -17% Wisconsin -31% Wyoming -17% U.S. -1-18% Chart Two - nursing home occupancy rates in 2011 Alabama 85.40% Alaska 91.30% Arizona 70.40% Arkansas 72.80% California 84.90% Colorado 80.50% Connecticut 88.70% Delaware 86.10% Florida 87.60% Georgia 85.30% Hawaii 91.40% Idaho 69.80% Illinois 78.50% Indiana 78.50% Iowa 79.70% Kansas 82.70% Kentucky 89.60% Louisiana 72.50% Maine 91.00% Maryland 87.60% Massachusetts 88.30% Michigan 85.00% Minnesota 90.60% Mississippi 88.20% Missouri 71.80% Montana 69.50% Nebraska 78.30% Nevada 81.60% New Hampshire 89.70% New Jersey 87.90% New Mexico 82.70% New York 91.80% North Carolina 86.20% North Dakota 90.30% Ohio 85.30% Oklahoma 67.30% Oregon 61.40% Pennsylvania 90.40% Rhode Island 92.20% South Carolina 89.50% South Dakota 100.00% Tennessee 84.90% Texas 69.90% Utah 66.30% Vermont 87.60% Virginia 88.20% Washington 80.40% DC 93.40% West Virginia 88.10% Wisconsin 83.10% Wyoming 81.60% U.S. 83.0% Chart Three - % increase in nursing home Medicaid expenditures between 2000 and 2012 Alabama 39% Alaska 115% Arizona 3068% Arkansas 119% California 90% Colorado 71% Connecticut 28% Delaware 8% Florida 77% Georgia 61% Hawaii -99% Idaho 92% Illinois 12% Indiana 92% Iowa 15% Kansas 26% Kentucky 51% Louisiana 67% Maine 13% Maryland 82% Massachusetts 31% Michigan 7% Minnesota -4% Mississippi 97% Missouri 29% Montana 26% Nebraska -6% Nevada 123% New Hampshire 51% New Jersey 11% New Mexico -98% New York 10% North Carolina 47% North Dakota 13% Ohio 13% Oklahoma 60% Oregon 38% Pennsylvania -6% Rhode Island 31% South Carolina 54% South Dakota 31% Tennessee -7% Texas 67% Utah 85% Vermont 50% Virginia 68% Washington 1% DC 54% West Virginia 94% Wisconsin 13% Wyoming 108% U.S. 31% Chart Four - actual Medicaid dollar increase in nursing home expenditures between 2000 and 2012 Alabama $255,754,231 Alaska $69,148,946 Arizona $475,688,312 Arkansas $360,783,181 California $1,998,500,869 Colorado $257,127,331 Connecticut $272,916,597 Delaware $7,535,638 Florida $1,220,177,047 Georgia $462,313,596 Hawaii (-$147,584,084) Idaho $102,276,230 Illinois $187,080,589 Indiana $705,632,599 Iowa $73,325,212 Kansas $92,238,026 Kentucky $284,788,789 Louisiana $346,159,432 Maine $25,352,670 Maryland $509,910,527 Massachusetts $429,138,089 Michigan $116,400,288 Minnesota (-$32,379,189) Mississippi $373,034,866 Missouri $213,203,966 Montana $33,015,318 Nebraska (-$21,419,330) Nevada $105,515,937 New Hampshire $110,248,344 New Jersey $177,204,426 New Mexico (-$161,591,525) New York $620,173,358 North Carolina $390,328,061 North Dakota $22,665,290 Ohio $274,931,768 Oklahoma $185,939,465 Oregon $90,763,291 Pennsylvania (-$231,182,111) Rhode Island $75,641,677 South Carolina $195,064,443 South Dakota $31,717,171 Tennessee (-$72,734,458) Texas $959,781,368 Utah $80,111,282 Vermont $39,090,314 Virginia $332,358,019 Washington $4,179,217 DC $76,178,032 West Virginia $259,072,260 Wisconsin $113,425,426 Wyoming $52,403,886 U.S. $12,401,404,686 Special thanks to Truven Health Analytics and Kaiser Commission for background data. Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins posted after 10/2013 can be found only at http://stevegoldada.blogspot.com/ Information Bulletins before 10/2013 are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.