Long Term Solutions for LongTerm Care

1
Long Term Solutions for Long-Term Care

• Families USA Health Action 2009 Conference
• Gene Coffey
• National Senior Citizens Law Center

2
State Motivation for Reform

• Medicaid is the single largest purchaser of LTC
  in the nation (99.3 billion in FY 2006, 49 of
  national LTC spending)
• 75 of Medicaid LTC spending for older people and
  adults with physical disabilities paid for
  institutional services
• Institutional services an entitlement under
  Medicaid HCBS is not
• Consumers, their family members and advocates
  have demanded more HCBS
• Federal Law contains integration mandate
• Growth in older population will increase demand

3
State Efforts to Transform Delivery of Long-Term
Care

• Topics
• Money Follows the Person
• Vermont Choices for Care Waiver
• Rhode Island Global Consumer Compact Waiver
• HCBS State Plan Option
• Other developments

4
Money Follows the Person

• Congress authorized 1.7 billion to support state
  efforts to transition Medicaid-enrolled nursing
  facility residents to the community
• 31 states awarded grants ranging from 5
  million to 140 million. Grants come in the
  form of enhanced federal match for HCBS services
  provided to MFP participants

5
Eligibility Requirements for MFP

• Eligible individuals must
• Have resided in an institution for at least six
  months and no more than two years
• Be receiving Medicaid coverage for their care
• In the absence of HCBS, require the level of care
  provided in an institution
• Be living in a qualified residence upon the
  first day of participation in MFP
• All states have had their protocols approved

6
Vermonts Choices for Care Program

• Medicaid Coverage for NF v. HCBS
• Meeting LTC clinical eligibility standard
• Guarantees coverage for institutional services
• Offers possibility of receiving HCBS, but only
  if
• State is operating an HCBS waiver program
• A slot is available in the program
• State is within its spending limits
• Vermont program targets Medicaids institutional
  bias by making HCBS an entitlement

7
Choices for Care Framework

• Single clinical eligibility standard for Medicaid
  NF/HCBS waiver eligibility split into three
  tiers
• Highest Need
• High Need
• Moderate Need

8
Choices for Care Framework, continued

• Highest Need guaranteed coverage and choice of
  service (NF or HCBS)
• High Need guaranteed choice of service but
  coverage only provided if funding is available
• Moderate Need eligible for select package of
  preventive services, coverage also dependent on
  funding availability

9
Attention to CFR

• Waiver has attracted national attention
• Report on Choices for Care released in November
  08. http//www.kaiserfamilyfoundation.org/medicai
  d/7838.cfm
• Rhode Island incorporated Choices for Care
  general framework in its proposed Global Consumer
  Compact Waiver

10
Rhode Island Global Consumer Compact Waiver

• Rhode Island to become first state to use global
  budgeting as a financing mechanism for all
  Medicaid populations and services
• Most significant changes are on the long-term
  care side
• RI incorporated Vermonts model into its waiver

11
Global Consumer Compact Waiver, continued

• Highest Need, High Need and Preventive need
• High need individuals may not receive coverage
  for institutional services
• Rhode Island behind Vermont in delivering HCBS to
  older adults and persons with physical
  disabilities
• Options available to RI that were not available
  to Vermont

12
HCBS State Plan Option

• Overview
• May only be made available to individuals who do
  not meet states Medicaid LTC standard
• States may cap individuals receiving benefit and
  can choose not to comply with statewideness
  mandate
• Services available include those specifically
  identified in 42 U.S.C. 1396n(c), not others
  requested by state that CMS might approve
• No budget neutrality mandate
• Income limit of 150 of FPL

13
HCBS State Plan Option, continued

• Two states have received approval to provide the
  service
• Nevada will provide coverage for adult day
  services, home-based habilitation and, for
  persons with chronic mental illness, day
  treatment or partial hospitalization.
• Iowa will provide coverage for case management
  and habilitation to individuals with a history of
  psychiatric illness.

14
Other Developments

• U.S. Administration on Agings Nursing Home
  Diversion program
• Aging and Disability Resources Centers

15

• Gene Coffey
• National Senior Citizens Law Center
• 1444 Eye Street, NW, Suite 1100
• Washington, D.C. 20005
• [phone]
• gcoffey_at_nsclc.org