Medicare Part LTC.

Steve Gold's Information Bulletin #269 Let's encourage the in-coming administration to remedy a long-standing problem for every state and for elderly and disabled persons -theLong-Term Care crisis. Some background information: Medicaid pays for services known as "Long-Term Care". These are primarily NOT medical services. They include home and community-based services (waivers, personal care services, home health), so people with physical, developmental and mental impairments can live in their own apartments and homes with their families and with appropriate services. Long-Term Care also includes institutions (nursing homes and ICF-MRs). Medicare pays only for a very few Long-Term Care services - a limited number of days in nursing homes and a few extremely restrictive community-based services. Eligibility for Medicaid is primarily income-based, while eligibility for Medicare is primarily related to one's prior employment history. Let's remember that Medicaid's and Medicare's covered services and eligibility are historical quirks and compromises made a half century ago in order to gain the votes to enact them. There is nothing sacrosanct about either. There is nothing necessarily rational about them. They are just what we have. In order to consider how to improve the current hodge-podge, it's important to look at a breakdown of the bulk of the Long-Term Care expenditures - namely Medicaid. Let's look first at the institutional side of LTC. In FY 2007, Medicaid's national expenditures (federal and state) for nursing facilities were $46.9 billion dollars - 15% of the entire national Medicaid budget (for all states and the federal government) and more than 60% of all payments made nursing facilities, including all private insurance. Medicaid's expenditures for institutions for people with developmental disabilities (Intermediate Care Facilities for MR) were $12 billion - 3.8% of the entire Medicaid budget. (Mental institutions are primarily paid through state-only expenditures.) That's right: keeping people with disabilities institutionalized cost Medicaid $59 billion which was 18.9% of all Medicaid expenditures and was 58.3% of all Medicaid's Long Term Care expenditures in FY 2007. Because Medicaid is a joint federal and state funded program, both the federal government (our federally elected Senators and Representatives), and our elected state officials spend more to institutionalized elderly and disabled people than they spend to integrate elderly and disabled people in the community or to keep them living with their families. Let's now look at the community side of Medicaid's Long-Term Care: all Medicaid waivers - for aged, disabled, people with MR/DD diagnoses, HIV/AIDs, TBI, children, adults - amounted to $27.5 billion in FY 2007 or 8.8% of the entire Medicaid budget. When one adds state plan's personal care and home health services to the waivers, the total Medicaid Long-Term Care amounted to total $42.3 billion - 13.4% of the entire national Medicaid budget and 41.7% of all Long Term Care funds. By adding both sides of Medicaid's expenditures - the institution and the community - one gets an astounding $100.8 billion going to Long-Term Care- a whopping 32.3% of Medicaid's entire budget goes to Long-Term Care. A Medicare Part LTC proposal: There are a number of advantages for Medicare to take over LTC for all people. First, by folding all Medicaid Long-Term Care into Medicare, states' will save significant expenditures. Second, with the federal government taking over all Long-Term Care services in Medicare Part LTC, we could finally break out of the historical institutional bias in the current Medicaid Act and offer people the choice to reside in their own homes with appropriate services. Third, this could present the new administration an important wedge to begin to restructure other components of national health care policy. Fourth, there could finally be some national uniformity in eligibility forservices and actual services. Fifth, the federal government has the ability to maintain these services in the future at a reasonable level of care. Last, there will be significant cost savings. Why? Presently, the bulk of the Medicaid's Long-Term Care expenditures go tothe most expensive, institutionally based services. This historical legislative bias will not be continued in the Medicare Part LTC. Instead, like with other Medicare services, persons with a red-white-and blue Medicare card will be able to chose where and from whom they wish to receive Long-Term Care. To ensure these services are both less expensive and what we as want, a consumer-control model for long-term care will be available. For example, if persons qualify for 10 hours a day of personal attendant care services, they could either go hire their own attendant or hire an an attendant from an agency. If consumers are not satisfied with attendants or a provider does not deliver, they can take their Medicare card to another attendant or agency, the same as they presently change doctors and hospitals. Rather than fifty agencies administering fifty different Long-Term Care programs, we could have one meaningful program administered the same way Medicare is presently administered - in a cost effective manner. In the forth coming months, please let your elected officials hear your voices. There will be changes. Whether they meet the needs and wishes of people with disabilities and elderly people we will see. Remember F. Douglas, "Power concedes nothing without a struggle."