Florida Medicaids Coverage of Long Term Care

1
Florida Medicaids Coverage of Long Term Care

• Presentation to the Florida Commission on
  Taxation and Budget Reform
• August 17, 2007
• Beth Kidder
• Bureau Chief for Medicaid Services
• Agency for Health Care Administration

2
Understanding and Preparing For Long Term Care

• Most people do not prepare for long term care
  needs until a
• health crisis occurs.
• The majority of Floridians ages 45-plus do not
  understand long
• term care coverage or costs.
• 74 of Floridians underestimate or dont know how
  much
• nursing facilitys cost on a monthly basis.1
• 54 incorrectly believe Medicare will pay for a
  long-term
• nursing facility stay.1
• 1 AARP The Costs of Long-Term Care Public
  Perceptions Versus Reality in 2006
  December 2006.

3
Types of Medicaid Long Term Care

• Nursing Facility
• Home and Community Based Services Waiver Programs
• A waiver of certain rules from the federal
  Centers for Medicare and Medicaid Services
• Allows Medicaid to provide long term care service
  in the home rather than in nursing facilities

4
Home and Community-Based Services Waiver Programs
Serving Seniors

• Waiver programs typically provide services such
  as
• Care management
• Help with bathing, eating, dressing
• Home delivered meals (Meals on Wheels)
• Help with housekeeping
• Medical supplies such as adult diapers
• Florida has 6 waiver programs that focus on
  seniors

5
Eligibility for Medicaid Long Term Care

• To qualify for Medicaid long term care,
  individuals must
• Meet nursing facility level of care
• Have income and assets within Medicaid limits
• Reside in a nursing facility that participates in
  the
• Medicaid program or be enrolled in a Medicaid
  home and community based services waiver program
• Individuals enrolled in waiver programs may need
  to meet additional criteria (e.g., have a
  diagnosis of Alzheimers, need assistance with
  bathing or dressing)

6
Seniors Prefer to Receive Care in Their Homes

• Studies and surveys consistently find that people
  of all ages prefer to receive services in their
  own homes rather than in nursing facilities.
• Some References on This Topic
• 1 T.J. Mattimore et al., Surrogate and Physician
  Understanding of Patients Preferences for Living
  Permanently in a Nursing Home, Journal of the
  American Geriatrics Society 45, no. 7 (1997)
  818-824.
• 2 AARP Let Us Choose A Survey of Floridians Age
  35 on LTC Choice 2006.

7
Institutional Bias

• Nursing facility care is an entitlement
  Medicaid must pay for nursing facility care for
  anyone who meets Medicaids medical and financial
  criteria
• Home and community based waiver funding is
  limited by Legislative appropriations -- the
  programs must stop enrolling seniors when the
  appropriated funds have been spent
• This results in what is called an institutional
  bias

8
The Majority of Medicaids Seniors Who Use Long
Term Care Receive the Services in Nursing
Facilities
Source Medicaid unduplicated recipient count
SFY 05-06
9
Medicaid Nursing Facility

• In Florida Medicaid pays for 60 of nursing
  facility bed days
• The average Medicaid daily rate for nursing
  facility care is 178.77

10
Medicaid Expenditures on Long Term Care for
Seniors (SFY 05-06)
11
Medicaid Enrollment and Expenditure Trends in
Nursing Facilities and Waivers
12
Questions