AARP recently issued an important report entitled "A Balancing Act: State Long-Term Care Reform," examining "the extent to which states have balanced the delivery of Medicaid-funded long-term services and supports(LTSS) to people in their homes ... and in institutions." http://www.aarp.org/ppi
"Balancing" means "serving a greater number of people with long-term care(LTC) needs in their homes or in more home-lie settings in their communities than in nursing homes; and shifting more resources toward home and community-based services to 'balance' Medicaid LTSS spending between institutional services and HCBS."
Advocates for older and disabled Americans should read the entire report and use it in their advocacy efforts. Let's not forget that the U.S.Supreme Court in the Olmstead decision more than nine years ago told states that they must affirmatively respond to persons' requests to reside in the community instead of in nursing homes! To the extent your State ha snot significantly balanced its Medicaid funds, it could be violating the Olmstead mandate, the ADA and illegally discriminating against persons who wish to reside in the community.
Here are some of AARP's findings:
"On average, Medicaid dollars can support nearly three older people and adults with physical disabilities in home and community-based services(HCBS) for every person in a nursing home. Thus, to the extent states provide HCBS instead of nursing home services, this shift in service can be both cost-effective and responsive to the preferences of people with disabilities."
However, "seventy-five percent of Medicaid LTC spending for older people and adults with physical disabilities paid for institutional services,compared to only 39 percent for people with mental retardation/developmental disability (MR/DD)."
"Finding: There is great variation among states, ranging from 5 percent or less to more than 50 percent of Medicaid LTSS funds going toward HCBS for older people and adults with disabilities." Where does your State place?
Finding: The "spending increase for MR/DD waiver programs was four times as great as the spending increase for ICF/MR from 2001 to 2006. In contrast, the spending increase for HCBS for older people and adults with physical disabilities was roughly equivalent to the spending increase for nursing homes over this period." How much increase did your State have?
Finding: "From 1999 to 2004, the number of HCBS participants increased in43 states and declined in seven. In 27 states, the number of nursing home participants increased over the same period, and the number declined in 23states."
Finding: "Progress in balancing Medicaid spending varied greatly among states. In 22 states, the dollar increase in Medicaid spending on HCBS from FY 2001 to FY 2006 was greater than the dollar increase on nursing home care. Another 27 states added more Medicaid funds to nursing home services than to HCBS during these five years." Where is your State?
The AARP report asks "Why have some states made more progress than others?" It lists 12 "success factors." However, the most important factor is "Philosophy - The state's intention to deliver services to people with disabilities in the most independent living situation and expand cost-effective HCBS options guides all other decisions."
Has your state balanced is its long-term services and supports? Or is it merely 'talking the talk' and not really committed to implement Olmstead? The numbers and dollars give the answer. Get the report and see how your state has done.
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
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