Happy Ninth Anniversary - Olmstead. Information Bulletin #261 (6/08).

from Information Bulletin produced by Steve Gold June 22, 1999 - The U.S. Supreme Court issued the Olmstead decision,holding that "unjustified institutional isolation of persons withdisabilities is a form of discrimination." The Court rejected the State'sargument that Medicaid statute reflected a congressional preference for"treatment in the institution over treatment in the community," pointingout that was not correct since 1981 when Medicaid provided for home andcommunity-based services and the U.S. Department of Health and HumanServices has had a "policy of encouraging" States to serve people withdisabilities in the community. The decision recognized that the ending of this discrimination would notoccur immediately. In 1999, the Court permitted States to have "waitinglists" for community services as long as such lists "moved at areasonable pace not controlled by the State's endeavors to keep itsinstitutions fully populated. "For people with disabilities, this decision was a clarion call. Nolonger, the disability and elderly advocates believed, would people beinstitutionalized if they wanted to reside in the community. Obviously,where one resides should be one's own choice. We all know, however, that the availability and allocation of fundsfrequently determines the "choice." Specifically, if you are on Supplemental Security Income, and/or your only source of income is eitheronly Social Security Disability Income or Social Security Retirement, your"choice" may be limited to where your State spends its Medicaid funds - innursing homes or in the community. AARP surveys point out that more than 90% of older Americans do not wantto reside in nursing homes, and according to the Minimum Data Set reports,the national percentages of people in nursing homes who want to live inthe community continues to increase steadily year by year (2003 -18.7%,2004 -19.9%, 2005 - 20.5%, 2006- 21.4%, 2007 - 22.0%, and 200822.8%)(check out your state http://www.cms.hhs.gov/MDSPubQIandResRep/click on MDS Activity Report and then Q1a). One might think that amount Medicaid expenditures going to nursing homeswould reflect the implementation of the Olmstead decision, nationalsurveys, and MDS data. How has your State done? Using FY 1999/Olmstead as a benchmark, we have calculated, by state, what was the percentage of Medicaid's "Long-Term Care" expenditures that wereallocated to services in the nursing institution versus in the community. The Centers for Medicare and Medicaid define "Long Term Care" to includethe total of expenditures, on the one hand, to institutions, i.e., nursinghomes, and, on the other hand, to the community, i.e., home health,personal care option and Medicaid waivers (we've limited the waiverexpenditures to aged, aged/disabled, and physical disabilities - which arethe counterparts for nursing facilities). We've followed the CMS dichotomy. Obviously, the greater the percentage of these Medicaid funds expended inthe nursing home institution, the lower the percentage in the community. It's like a scale- as one side goes down, the other increases. While thefollowing data is provided in percentages, it is critical to rememberthere are billions of dollars involved and the ratio of expendituressignificantly impacts whether one has a meaningful choice. That is, themore your State spends on nursing facilities, the less it will have tospend on the community. We receive numerous inquiries from people who do not want to beinstitutionalized in nursing homes or who are in them and want to live inthe community. The only way to achieve real "choice" is to provide peoplewith Medicaid services where they want them. "Waiting lists" for servicesare not services. Living in fear of being institutionalized or livingwith fear because one is institutionalized is not the type of a "choice"either the ADA or the Olmstead decision intended. Whether the promise of Olmstead will be achieved depends entirely on theelderly and disability advocates! Those states that have moved thepercentages to greater equality between the community and the institutionmust have terrific, effective advocates and/or empathetic electedofficials and/or compassionate administrators. For some States it is "Olmstead, happy ninth anniversary!" For manyothers, it is not. Below we provide two lists of States. The first is the FY 1999 benchmark.In FY1999, nationally, 80.8 % of Medicaid's Long Term Care funds werespent on nursing homes and19.2 % in the community. The second list provides percentages for FY 2006, the last year for whichwe have data. In FY 2006, nationally, 71.4% of Medicaid's Long Term Carefunds were spent on nursing homes and 28.6 % in the community - a shift of9.4%. (The FY 2007 data will be available later in the summer and we willupdate this information. Data is from Medstat to whom we are extremelyappreciative.)Check out how much progress your State has made since the Olmstead decision. Compare the FY1999 benchmark with FY 2006. For example,Alabama in FY 1999 spent 87.6 % of its Medicaid Long Term Care funds innursing homes and 12.4% in the community. Seven years later, in FY 2006,it spent 88.8% of its Medicaid LTC funds in nursing homes and 11.2% in the community. Using the data for your State, disability and elderly advocates should ask whether the change between FY 1999 and FY 2006 is satisfactory, whether it reflects what the Supreme Court in the Olmstead decision intended, whether it provides elderly and disabled people in your State with a choice where they want to receive services, and what the advocates will do about the pace of change. FY 1999: % of Medicaid Long Term Care Expenditures in Nursing Homes vs. % in the Community National .....80.8% LTC expenditures in nursing homes.. 19.2% in the community. Alabama ............87.6.% nursing homes............12.4 %community Alaska .............74.2 % nursing homes............35.8% community Arizona* .......... 25.5% nursing homes............74.5% community Arkansas........... 66.0% ............ 34.0% California......... 80.7% ............19.3% Colorado............70.3% ............39.7% Connecticut.........83.5 % ............16.5% Delaware............90.9% ............ 9.1% D. C................85.0% ............15.0% Florida.............87.5 % ............12.5% Georgia.............83.4% ............16.6% Hawaii..............90.3% ............9.7% Idah................71.8% ............ 28.2% Illinois............92.0% ............8.0% Indiana.............91.8% ............ 8.2% Iowa................84.5% ............15.5% Kansas..............68.8% ............ 31.2% Kentucky............78.6% .............21.4% Louisiana.......... 91.0% ............ 9.0% Maine.............. 80.0% .............20.0% Maryland............86.4% ............ 13.6% Massachus...........84.3% ............ 15.7% Michigan............85.9% .............14.1% Minnesota...........79.9% .............20.1% Mississippi.........94.0% ............ 6.0% Missouri............81.2% ............ 18.8% Montana.............75.1% ............24.9% Nebraska............85.2% ............14.8% Nevada..............80.1% ............19.9% New Hampshire.......90.6% ............9.4% New Jersey..........79.3% ............20.7% New Mexico..........87.8% ............12.2% New York ...........70.1% ............29.9% North Carolina......67.2% ...........32.8% North Dakota........95.0% ............5.0% Ohio................88.1% ............11.9% Oklahoma............85.7 % ............14.3% Oregon............. 54.9% ............45.1% Pennsylvania........96.5% ............3.5% Rhode Island........92.3% ............7.7% South Carolina......79.0% ...........11.0% South Dakota........94.1 % ...........5.9% Tennessee...........98.7 % ...........1.3% Texas.............. 73.9 % ........... 26.1% Utah................92.3 % ............7.7% Vermont............ 81.9 % ............18.1% Virginia............81.5% ...........19.5% Washington .........62.1 % ............37.9% West Virginia.......76.6 % .............23.4% Wisconsin...........78.5 % ............ 11.5% Wyoming ............83.0% ..............17% *Arizona has had a statewide managed care Medicaid program, so the figures may not accurately reflect the distribution. FY 2006: % of Medicaid Long Term Care Expenditures in Nursing Homes vs. % in the Community National...71.4% LTC expenditures in nursing homes..... 28.6% in the Community. Alabama .............88.8% nursing homes............11.2% community Alaska ............. 48.4% nursing homes............51.6% community Arizona ............ 60.6%nursing homes.............39.4% community Arkansas.............74.0% ............26.0% California.......... 51.7% ............ 48.3% Colorado............ 66.6% ............33.4% Connecticut..........80.1% ............19.9% Delaware.............86.9% ............13.1% D. C.................72.9% ............ 27.1% Florida..............87.3% ............12.7% Georgia..............83.8% ............16.2% Hawaii...............82.9% ............17.1% Idaho................59.7% ............ 40.3% Illinois.............79.5% ............20.5% Indiana..............91.9% ............ 8.1% Iowa.................75.3% ............24.7% Kansas.............. 64.1% ............35.9% Kentucky............ 80.7% .............19.3% Louisiana........... 82.6% ............ 17.4% Maine................75.0% .............25.0% Maryland.............83.5% ............ 16.5% Massachus............75.5% ............24.5% Michigan.............84.0% ............16.0% Minnesota............57.0% ............ 43.0% Mississippi..........97.6% ............ 2.4% Missouri.............70.2% ............ 29.8% Montana..............71.2% ............ 28.8% Nebraska.............79.7% ............ 20.3% Nevada...............67.8% ............32.2% New Hampshire........86.6% ............13.4% New Jersey...........79.5% ............20.5% New Mexico...........46.3% ............53.7% New York ............63.9% ............36.1% North Carolina.......56.9% ............43.1% North Dakota........ 94.3% ............5.7% Ohio.................78.9% ............21.1% Oklahoma.............73.3% ............26.7% Oregon.............. 45.1% ............54.9% Pennsylvania.........88.0% ............12.0% Rhode Island.........88.4% ............11.6% South Carolina.......79.9% ...........20.1% South Dakota.........89.5% ...........10.5% Tennessee............98.9% ...........1.1% Texas................54.4% ...........45.6% Utah.................90.2% ............9.8% Vermont..............72.8% ............27.2% Virginia.............76.9% ...........23.1% Washington ..........45.4% ............54.6% West Virginia........77.8% .............22.2% Wisconsin ...........69.7% ........... 30.3% Wyoming .............80.1% ............19.9% Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins 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 stevegoldada@cs.com or call 215-627-7100. --Steve Gold, The Disability Odyssey continues. Back issues of other Information Bulletins are available online athttp://www.stevegoldada.com