Olmstead 15th Anniversary [Part Three] - How Much Progress Has Your State Made? Information Bulletin # 392 (6/2014). In this Olmstead 15th Anniversary Information Bulletin, we will compare the Medicaid expenditures State-by-State for Long Term Services and Supports (LTSS), including expenditures on both nursing homes (institutions) and community-based programs. In Fiscal Year 2000, the first year after the Supreme Court held that “unnecessary isolation” was discrimination against people with disabilities. States varied quite a lot in the percentage of their LTSS spending that went to the community-based programs. Nationally, only 18.7% of LTSS spending went to the community-based programs and the remainder went to programs that segregate people with disabilities in nursing homes. The worst States in 2000, those that expended less than 10% of their LTSS in the community were Illinois, Indiana, Louisiana (5.7%), Mississippi (6.7%), New Hampshire, North Dakota (3.4%), Pennsylvania (3.2%), Rhode Island, South Dakota, Tennessee (0.5%), Utah, and Wyoming. Chart One below lists the rates for each State. By FY 2012, the percentage of Medicaid LTSS expenditures in the community had increased to 38.8%. There were only four States that had under 10% Medicaid community-based expenditures: Alabama, Indiana, Kentucky, and South Dakota. However, another four States were listed as having zero expenditure in the community: Arizona, Hawaii, Rhode Island and Tennessee. Chart Two below lists the rates for each State. By FY 2012, many of the worst States from FY 2000 had made really significant progress in funding community-based services, including, Illinois, Louisiana, Mississippi, and Pennsylvania. The improvement in these States demonstrates a real commitment to changing their allocations to comply with Olmstead. Obviously, there has been a lot of progress. However, it is important to understand that the spending on the institutional side of the leger has not been stationary between FY 2000 and FY 2012. In terms of total Medicaid dollar expenditures during these years, the institutional and community sides each increased by $12 billion. Chart three below lists the increases in each State. What is particularly interesting about the total dollar expenditures is that some States that decreased their total combined institutional and nursing home expenditures between FY 2000 and FY 2012 were also able to increase their total community-based Medicaid expenditures. These States, which should receive exceptional kudos, include Minnesota (reduced institutional expenditures by $32 m and increased community by $1 b), Nebraska (reduced institutional expenditures by $21 m and increased community by $13 m), New Mexico (reduced institutional expenditures by $162 m and increased community by $7 m), Pennsylvania (reduced institutional expenditures by $231 m and increased community by $737 m), Tennessee (reduced institutional expenditures by $72 m and also decreased community by $6 m). However, there were States that increased their total institutional expenditures and while actually reducing their community-based expenditures between FY 2000 and FY 2012. These States, were Connecticut (increased institutional expenditures by $273 m and decreased community by $16 m), Kentucky (increased institutional expenditures by $284 m and decreased community by $70 m), Rhode Island (increased institutional expenditures by $75 m and decreased community by $20 m). We are very disappointed and surprised with those States that have actually decreased their total Medicaid expenditures for community-based programs. How can they be complying with the Olmstead decision? Are all of the people with disabilities who want to live in the community able to do so? Are there any people with disabilities still at risk of unnecessary isolation? What about those States that in FY 2012 still spent less than 10% of their LTSS on community-based services? How do they comply with Olmstead? How do they prevent unnecessary isolation? What are the advocates for the aging and the advocates for physically disabled people doing in those States? It is difficult to believe that States are complying with the Olmstead and the ADA when they are spending such a small percentage of their LTSS on community-based programs. It is difficult to reconcile a commitment to ending unnecessary isolation with many States’ increased spending on institutions that segregate people with disabilities. Advocates for the aging and physically disabled people regardless of their ages must speak up and demand full compliance with Olmstead and a real commitment to community-based programs. Chart One – % FY 2000 State Medicaid Expenditures In Community Alabama 11.0% Alaska 28.8% Arizona 14.1% Arkansas 30.0% California 22.6% Colorado 26.9% Connecticut 16.9% Delaware 13.1% Florida 10.1% Georgia 14.2% Hawaii 14.2% Idaho 26.0% Illinois 8.5% Indiana 7.9% Iowa 11.1% Kansas 26.6% Kentucky 22.6% Louisiana 5.7% Maine 17.1% Maryland 12.4% Massachusetts 17.3% Michigan 11.3% Minnesota 21.8% Mississippi 6.7% Missouri 20.9% Montana 24.9% Nebraska 16.9% Nevada 17.1% New Hampshire 9.9% New Jersey 10.0% New Mexico 11.4% New York 29.9% North Carolina 34.6% North Dakota 3.4% Ohio 11.7% Oklahoma 16.3% Oregon 48.0% Pennsylvania 3.2% Rhode Island 7.5% South Carolina 22.5% South Dakota 6.2% Tennessee 0.5% Texas 28.5% Utah 8.3% Vermont 23.1% Virginia 17.0% Washington 39.4% Washington DC 11.4% West Virginia 30.2% Wisconsin 19.6% Wyoming 9.0% U.S. 18.7% Chart Two -% FY 2012 State Medicaid Expenditures In Community Alabama 9.6% Alaska 62.4% Arizona 1.0% Arkansas 23.5% California 33.6% Colorado 26.7% Connecticut 12.8% Delaware 13.9% Florida 13.7% Georgia 25.0% Hawaii 0.0% Idaho 42.8% Illinois 30.6% Indiana 7.6% Iowa 14.8% Kansas 29.7% Kentucky 9.8% Louisiana 27.2% Maine 28.3% Maryland 18.0% Massachusetts 34.1% Michigan 21.6% Minnesota 61.9% Mississippi 21.6% Missouri 35.2% Montana 31.2% Nebraska 20.5% Nevada 28.3% New Hampshire 15.1% New Jersey 13.3% New Mexico 91.3% New York 35.8% North Carolina 35.1% North Dakota 10.8% Ohio 22.5% Oklahoma 28.4% Oregon 59.3% Pennsylvania 19.4% Rhode Island 0.0% South Carolina 23.5% South Dakota 9.8% Tennessee 0.0% Texas 46.3% Utah 17.0% Vermont 20.0% Virginia 42.4% Washington 60.6% Dist. of Columbia 52.1% West Virginia 25.9% Wisconsin 44.4% Wyoming 13.8% U.S. 38.8% Chart Three – Dollar Increases Between Between 2000 and 2012 in Nursing Homes and in Community Nursing Homes Community Alabama $255,754,231 $16,285,283 Alaska $69,148,946 $189,789,166 Arizona $475,688,312 $2,662,490 Arkansas $360,783,181 $74,068,697 California $1,998,500,869 $1,478,460,824 Colorado $257,127,331 $91,947,814 Connecticut $272,916,597 (-$15,486,259) Delaware $7,535,638 $2,118,904 Florida $1,220,177,047 $268,218,703 Georgia $462,313,596 $280,885,524 Hawaii (-$147,584,084) (-$24,655,070) Idaho $102,276,230 $120,753,121 Illinois $187,080,589 $611,247,113 Indiana $705,632,599 $54,927,012 Iowa $73,325,212 $37,289,090 Kansas $92,238,026 $59,833,671 Kentucky $284,788,789 (-$70,531,195) Louisiana $346,159,432 $291,254,656 Maine $25,352,670 $47,704,797 Maryland $509,910,527 $160,185,965 Massachusetts $429,138,089 $650,078,374 Michigan $116,400,288 $269,903,742 Minnesota (-$32,379,189) $1,091,003,677 Mississippi $373,034,866 $181,099,249 Missouri $213,203,966 $317,567,671 Montana $33,015,318 $30,784,373 Nebraska (-$21,419,330) $13,345,040 Nevada $105,515,937 $57,853,840 New Hampshire $110,248,344 $33,967,631 New Jersey $177,204,426 $98,487,894 New Mexico (-$161,591,525) $7,211,233 New York $620,173,358 $1,181,029,041 North Carolina $390,328,061 $222,000,788 North Dakota $22,665,290 $18,278,558 Ohio $274,931,768 $421,962,758 Oklahoma $185,939,465 $136,516,642 Oregon $90,763,291 $260,920,140 Pennsylvania (-$231,182,111) $737,149,759 Rhode Island $75,641,677 (-$20,073,338) South Carolina $195,064,443 $66,138,140 South Dakota $31,717,171 $7,781,163 Tennessee (-$72,734,458) (-$5,487,090) Texas $959,781,368 $1,493,636,696 Utah $80,111,282 $27,157,320 Vermont $39,090,314 $5,830,447 Virginia $332,358,019 $504,163,948 Washington $4,179,217 $553,176,628 DC $76,178,032 $217,231,477 West Virginia $259,072,260 $67,828,539 Wisconsin $113,425,426 $587,263,336 Wyoming $52,403,886 $11,347,656 U.S. $12,401,404,687 $12,922,115,638 Thanks again to Truven Health Analytics for compiling the 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.