Per Capita LTC Expense Growth by State

1. Per capita Medicaid nursing facility expenditures: Between 1999 and 2006, the national per capita average increased in Medicaid nursing home expenditures from $130.41 (FY 1999) to $161.26 (FY2006), an increase of $30.85. (To calculate the per capita expenditures,one divides the total population in your state into the total amount of Medicaid expenditures in your state allocated to nursing homes.) In simple language, in 2006 nationally each state spent (your taxes) an average of$161.26 for each person in the state's Medicaid institutional nursing facilities. Between 1999 and 2006, if your State really had intended to comply with the Olmstead decision, one would not expect to see an increase far above the national per capita average increase. Obviously, the higher a Medicaid per capita expenditure for nursing facilities, the greater the incentive the nursing facilities have to keep the beds occupied. Here are the States that had the largest increases in nursing home per capita expenditures from 1999 to 2006. [The national average per capita increase was $30.85.] NJ $118.20, AK $94.34, MS $89.93, ND $87.65, DE $83.83, CN $79.29, and AR, $75.39. Here are the states with the lowest increases in nursing home per capita expenditures: Three states reduced their per capita nursing home expenditures between1999 and 2006: WA -$11.63, MN -$10.53, and NE -$1.30. Four states kept their per capita nursing home expenditure increases from 1999 to 2006 to a minimum and far below the national average increase of$30.85: TX $1.87, WI $2.10, MO $3.11, and OR $8.18 2. Per capita Medicaid community-based service expenditures: If a state wanted to comply with the Olmstead decision and truly offer services "in the most integrated setting," one would expect to see substantial increases in per capita expenditures for community-based Medicaid services. In fact, between 1999 and 2006, the national per capita average increase in Medicaid community-based long term care expenditures increased from $28.82 (FY 1999) to $63.96 (FY 2006), an increase of $35.14 [compared to the nursing home per capita increase of $30.85]. Several obvious points: in FY 1999, the Medicaid nursing facility per capita average expenditure was $130.41 and increased to $161.26 in FY2006, compared to the Medicaid community-based per capita average expenditure in FY 1999 of $28.82 to $63.96 (FY 2006). There is still a tremendous institutional bias; the institutional versus community-based expenditure differences are closing at a snail's pace! The following six States had the largest per capita increases in Medicaid community-based service expenditures between FY 1999 and FY 2006: AK $165.83, NM $105.38, CA $81.91, MN, $81.11, NY $67.14, and ID $60.58. The following ten States had the smallest per capita Medicaid increased expenditures in community-based long term services between FY 1999 and FY2006: One state actually spent less per capita in community-based services in FY2006 than in FY 1999: MS - $1.82. Nine states increased their per capita Medicaid community-based service expenditures by less than $10 over the seven years: TN $1.16, UT $3.68, AL $5.74, IN $7.61, FL $7.49, ND $7.53, KY $8.16, MI $8.33, and AR $9.29. As a great philosopher once said, "show me the money." Once elderly and disability advocates see how Medicaid funds have been expended in your State, it should not be too difficult to figure out whether or not your State officials are committed to offering community-based services as a real choice. It is time to analyze whether your State administrators are truly committed to implementing the Olmstead decision and the ADA, or whether they are merely giving you lip-service. 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