Public Policy Seminar

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Public Policy Seminar

• National Association of
• State Head Injury Administrators
• March 26, 2009
• Nancy Thaler, Executive Director
• National Association of State Directors of
• Developmental Disabilities Services
• NASDDDS

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Why Reform?

• Costs are escalating and the growth is
  unsustainable
• We dont like what we are getting for our money

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Costs
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Each day, for the next two decades, more than
10,000 Baby Boomers will become eligible for
Social Security. (Peterson Foundation)
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Growth in LTC Expenditures
109
100
92
41
37
75
32
54
32
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Impact on the Federal Budget
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We Dont Like What We are Getting for our Money
Institutional Bias
65 of expenditures in nursing homes and
ICFs/MR.
15 of the people are in nursing homes and
ICFs/MR.
KCMU and Urban Institute Kaiser Medicaid Facts
Medicaid and Long-Term care Services and
Supports February 2009
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DD is Rebalancing
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Interesting Data on Cost
Medicare is outside this analysis.
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What Form Should Long Term Care
Reform Take?
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Managing Medicaid Home Community Services Funds
for Better Outcomes
Medicaid Community

• Individual Budgets
• Fiscal Intermediaries
• Hiring Authority
• Support Brokers
• 1915 (I)
• 1915 (j)
• Community Choice Act

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Rebalance Institution and Community
Medicaid Community Institutional
Care Care

• Combine Institution Community Funding a
  global budget
• 1115 demos
• 1915 B/C combos
• 1915 A
• Other??????
• Replace institutional entitlement with community
  entitlement

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Combine Long Term Care and Acute Care
Medicaid Acute Long Term Care
Care

• Implement
• Consumer
• Choice
• Control
• or not

• Combine
• Acute care
• LTC Funding

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Balance Medicare and Medicaid
Medicaid Acute Long Term Care
Care

• Combine
• Medicare
• Medicaid

8 million people
Medicaid
Acute Long Term Care Care
Medicare
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Other LTC Reforms that Reduce Pressure on the
Public System

• Long Term Care (LTC) Insurance Incentives
• Class Act voluntary public insurance program
  with tax incentive to save for LTC Services

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Do we just need to give people control over an
individual budget or do we need a system?

• Examples of service system responsibilities
• Intake and eligibility
• Helping the person figure out what they need and
  what services are available do an individual
  plan
• Supporting families
• COORDINATION of services essential to all LTC
  reform options
• Provider recruitment, training, credentialing and
  monitoring
• Determining individual budget amount monitoring
  expenditures
• Emergency and crisis intervention
• Advocacy
• Assisting with access to non LTC services i.e.
  employment, housing, medical
• Assisting with transition

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What System Manages Services?

• LTC Agency all ages
• Medicaid Agency
• Disability Agency
• Developmental Disabilities Agency
• Private Management Entities Managed Care
  Organizations

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NASDDDSHealth Care Reform Long-Term Services
and Supports for Citizens with Developmental
Disabilities
December 2008 www. nasddds.org
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• The ultimate outcome of supports and services
  should be a good everyday life in the community.
• People with developmental disabilities must have
  control over their lives
• Employment is a central feature of independence
  and life in the community
• Families play a central role in supporting adults
  and children with disabilities. Their role and
  need for assistance must be factored into the
  design and provision of supports
• Paying family members/relatives to provide care
  in certain situations should be an element in any
  reform effort
• Family members who provide support, particularly
  family members who are aging, may themselves have
  a disability and need their own support services

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• Waiting Lists must be addressed.
• Services must be coordinated and managed.
• Disability-specific expertise must be retained as
  part of the service system
• Quality of services and supports are an essential
  feature of a service system.
• Information technology is an essential element to
  both delivering services and managing quality

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Nancy Thaler Executive Director National
Association of State Directors of Developmental
Disabilities Services 113 Oronoco
Street Alexandria, VA 22314 703-683-4202 nthaler_at_n
asddds.org