2007 Institution vs Community-Based Medicaid Services

Steve Gold's Information Bulletin # 263 (10/08) Each State's FY 2007 Medicaid data, submitted to CMS for reimbursement and compiled by Thompson/Medstat, provides extremely helpful information to analyze your State's distribution of its Long Term Care expenditures between its Institutional versus Community-Based Services. How a state allocates its Long Term Care expenditures demonstrates its commitment to provide the elderly and persons with disabilities a choice between unnecessary institutionalization and living in the community. Let's repeat - "show us the money" and where a state spends it, and you can see how much the state respects both the ADA and the Olmstead decision. Remember that the Supreme Court in 1999 - eight years ago -told states to end unnecessary institutionalization! The following data shows how much your state respects the ADA and the Olmstead decision. Nationally, for "all disabilities," 58.3% of the long term care expenditures went to institutions, i.e, both to nursing homes (for physically disabled persons of all ages) and to intermediate care facilities (for persons with MR/DD). 41.7% went for community based services, i.e., for all MA waivers (i.e., both Aged and Physical Disabilities and MR/DD), "personal care" option, and home health services in the community. As you all know, we live with the historical disability divide - persons with MR/DD, on one hand, and the elderly and persons with physical disabilities of all ages, on the other hand. As unfortunate as the divide is and as much as it perpetuates divisions in the disability community,it's what we have. MA expenditures and analysis follow this divide. When "all disabilities" are broken down into MR/DD and Aged/PD, a dramatic difference exists in the above 58.3% institutional vs 41.7% community national long term care distribution. For persons receiving MR/DD services, nationally only 36.9% went for institutions (ICF-MRs) and 63.1% was spent for community-based (waiver)services. Thus, significantly less Medicaid funds went to provide services for persons with MR/DD in institutions than in the community. In dollars, $12 b was spent on institutions but $20.5 b was spent for community-based services. In contrast, for the aged and persons with physical disabilities, 69% was expended on institutional services and 31% on community-based services. In dollars, nursing homes received $46.9 b but only $21.1 b was spent for community-based services. Why the lopsided distribution based on type of disability? Let's look at the differences in each State. The following chart providestwo columns - the first for MR/DD and the second for Aged/PD. How does your State compare? Advocates should make two comparisons. First, how is your State doing for each MR/DD and Aged/PD with regards to leveling the playing fields between institutional and community-based services? Second, how is your State doing when you compare MR/DD and Aged/PD expenditures? % of Medicaid Long Term Care expenditures for institutional services versus community services. ..............................MR/DD......Aged/PD ..........................................Inst./comm...Inst./comm. National ...................36.9%/63.1% 69%/31% Alabama ......................12.2/87.8 86.9/13.1 Alaska ........................0.2/99.8 49.4/50.6 Arizona ............................N/A 36.0/64.0 Arkansas......................58.0/42.0 74.1/25.9 California....................37.7/62.3 47.9/52.1 Colorado.......................8.1/91.9 65.1/34.9 Connecticut...................34.3/65.7 79.3/20.7 Delaware......................26.3/73.7 86.3/13.7 D.C ..........................72.5/27.5 65.1/34.9 Florida.......................26.4/73.6 82.5/17.5 Georgia.......................24.4/75.6 76.0/24.0 Hawaii.........................7.9/92.1 82.2/17.8 Idaho.........................50.4/49.6 59.6/40.4 Illinois......................61.9/38.1 75.1/24.9 Indiana.......................43.2/56.8 85.5/14.5 Iowa..........................51.1/48.9 73.8/26.2 Kansas........................20.4/79.6 64.8/35.2 Kentucky......................42.0/58.0 81.1/18.9 Louisiana.....................53.6/46.4 73.2/26.8 Maine.........................23.5/76.5 73.4/26.6 Maryland......................10.2/89.8 84.1/15.9 Massachusetts.................26.7/73.3 73.6/26.4 Michigan.......................9.7/90.3 81.0/19.0 Minnesota.....................16.2/83.8 53.4/46.6 Mississippi..................100.0/00.0 97.8/2.2 Missouri......................23.2/76.8 68.9/31.1 Montana.......................13.3/86.7 70.7/29.3 Nebraska..................... 31.8/68.2 77.7/22.3 Nevada....................... 25.5/75.4 64.9/35.1 New Hampshire..................1.7/98.3 85.6/14.4 New Jersey....................55.1/44.9 79.0/21.0 New Mexico.................... 7.8/92.2 39.3/60.7 New York .....................39.6/60.4 60.7/39.3 North Carolina................52.3/47.7 57.3/42.7 North Dakota..................48.2/51.8 93.7/6.3 Ohio..........................48.4/51.6 79.2/20.8 Oklahoma......................32.5/67.5 71.3/28.7 Oregon........................0.0/100.0 43.5/56.5 Pennsylvania..................32.4/67.6 87.3/12.7 Rhode Island...................3.5/96.5 87.4/12.6 South Carolina................44.7/55.3 77.0/23.0 South Dakota..................19.6/80.0 88.5/11.5 Tennessee.....................28.4/71.6 98.7/1.3 Texas.........................62.3/37.7 55.7/44.3 Utah..........................33.3/66.7 89.3/10.7 Vermont.............................N/A 71.5/28.5 Virginia......................40.2/59.8 73.2/26.8 Washington ...................22.1/77.9 44.4/55.6 West Virginia.................21.5/78.5 76.6/23.4 Wisconsin ....................23.1/76.9 69.3/30.7 Wyoming ......................18.6/81.4 79.6/20.4 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