LongTerm Care Community Diversion Nursing Home Diversion

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Long-Term Care Community Diversion (Nursing Home
Diversion)
Senate Committee on Health Human Services
Appropriations March 9, 2006 Presented by
Chuck Corley, Director of the Division of
Statewide Community-Based Services
Jeb Bush Governor
Carole GreenSecretary
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Program History Design

• In 1997, the Legislature authorized the
  Department of Elder Affairs (department), in
  consultation with the Agency for Health Care
  Administration, to implement the Long-Term Care
  Community Diversion Pilot Project (diversion
  project)
• The project was designed to target individuals
  who would otherwise require Medicaid nursing home
  placement and provide them with a comprehensive
  array of home and community-based services at a
  cost less than nursing home care.
• The diversion project coordinates medical and
  long-term care and provides a full continuum of
  long-term care services for individuals who are
  dually eligible for Medicaid and Medicare. These
  services include all home and community-based
  care services, assisted living facility care,
  prescription drugs (prior to January 1, 2006),
  Medicare coinsurance and deductibles, and nursing
  home care when needed.

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Progression of Approved Counties of Operation
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Presence of Providers by County
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History of Appropriations Clients-Served
Fiscal Year Funding (rounded) Clients Served FY
97-98 23 million N/A FY 98-99 23
million 118 FY 99-00 23 million 814 FY
00-01 23 million 1,074 FY 01-02 26
million 1,165 FY 02-03 31 million 1,216 FY
03-04 68 million 4,247 FY 04-05 128
million 7,480 FY 05-06 210 million 9,228
(projected) Unduplicated Total Clients
Served 12,650 The program has served 7,672
clients as of 02/06, and expects to serve an
additional 389 new clients each month for the
remainder of the state fiscal year.
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History of Clients Served Continued
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EnrollmentJuly 2005 - June 2006
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Projected EnrollmentJuly 2006 - June 2007
Projections assume the program continues a net
gain of 200 clients per month.
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Contemporary Issues

• Medicaid Aged and Disabled Adult Waiver (ADA)
  Assisted Living for the Frail Elderly Waiver
  (ALE)
• FY 05-06 ADA clients served 12,100
• FY 05-06 ALE clients served 4,800
• Program integrity
• Systems capabilities (CIRTS, CARES, etc.)
• Projected totals

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Contemporary Issues (Continued)

• Rate setting
• Oversight
• Length of enrollment period (eligibility,
  assessment and referral to MCO)
• Personal family decisions
• Physician form
• Plan involvement in the eligibility process