Downturn is good time to evaluate LT care
While the Patient Protection and Affordable Care Act offers opportunities to enhance long-term care services in Medicaid, one obvious obstacle is fiscal.
For instance, the 1915(i) Home and Community-Based Services (HCBS) state plan option was revised to broaden the scope of covered services. States can now use it to serve the same population that meets both the functional and financial criteria of their existing HCBS waivers.
However, since the legislation requires statewide coverage and doesn't allow program enrollment ceilings, few states are likely to be able to afford this option.
"Most states are cutting programs in one way or another. They are either restricting services or lowering provider rates," says Leslie Hendrickson, PhD, principal of Hendrickson Development, an East Windsor, NJ-based consulting group that helps to develop and strengthen long-term care programs.
HCBS cuts are possible
When the enhanced federal medical assistance percentage (FMAP), recently extended through June 30, 2011, expires, however, the federal restrictions on eligibility reductions that were a condition of receiving this money also disappear. "That is a savings option that has been off the table. But if state problems persist for another year or two, you will probably see eligibility reduction as well," says Dr. Hendrickson.
"I don't see a lot of new money coming in, but what I do see is a smart continuation of current trends and efficient use of what is there," says Dr. Hendrickson.
On the state level, Dr. Hendrickson points to Pennsylvania's transition program as a successful model. As part of the program, housing coordinators were hired and local housing regional coordinating committees were set up for various state agencies.
Lack of housing has made transitioning residents out of nursing homes difficult in some programs. Now, efforts are being made to address this at the federal level.
"All of a sudden, you have the awareness that helping people leave nursing homes is in some part a housing issue," says Dr. Hendrickson. "There is more organization and planning going on in these upper department levels on how to make the programs mesh a little easier."
For states with severe shortfalls, Dr. Hendrickson says that "budget deficits are simply so horrendous that everything gets put on the table. It is easy to cut HCBS, so that seems to get put on the table a little bit faster by the budget folks."
Nursing home and HCBS reimbursement rates have been cut or frozen in many states. For example, in New Jersey, nursing homes did not receive a cost of living increase in Medicaid reimbursement rates for FY 2011. "That's a $56 million dollar hit. That same pattern is happening in other states Maryland, Massachusetts, Indiana," says Dr. Hendrickson.
The bottom line is that this is a time for Medicaid programs to operate as efficiently as possible. "Folks need to plan as carefully as they can, and try to ride through the lean years," says Dr. Hendrickson. "When the budget situations improve, as they inevitably will, you will cope with the unmet needs that stack up during the recession."
Dr. Hendrickson says that in the meantime, state Medicaid directors should do these things:
1. Build better data systems for long-term care.
"There is still a lot of room for building better data systems, studying your programs, and organizing what you do better," says Dr. Hendrickson. "There are states that don't have common assessments. They can't compare the characteristics and costs of people in nursing homes vs. those getting care in the community."
2. Analyze the cost-effectiveness of the Money Follows the Person programs and closing large state institutions.
"Money Follows the Person programs are now operating in 30 states. Just what are the savings of helping people move to lower-cost methods of care?" asks Dr. Hendrickson. "It's about time that both state and federal budget staff paid attention to this."
3. Consider the interrelationships between programs.
As a former senior budget analyst in a Medicaid program, Dr. Hendrickson says that in his opinion, budget analysts often fail to consider the interrelationships between users of programs.
"Budget analysts see lines on paper and see dollars attached to them, and just start cutting," he says. "The only intellectual tool they use is a scissor. Once you start cutting some of these programs, you're going to be increasing the number of people going to nursing homes."
The idea is to manage programs as a group, instead of viewing them as a separate series of line items or making across-the-board cuts. "Don't ignore the give and takes among the programs. All of this long-term care stuff is very interrelated," says Dr. Hendrickson. "If you think of programs in isolation, you're really missing the boat."
The fact is, says Dr. Hendrickson, people are moving between these programs continuously by the thousands. A data system is needed to link all the programs together, to shed light on the reasons for the movement, and the costs and characteristics of the people who are moving.
"In a time of no money, this is a good activity to do," says Dr. Hendrickson. "This is a great time to plan. Unless you become more efficient now, you will have larger and more complicated problems in the future."
While the Patient Protection and Affordable Care Act offers opportunities to enhance long-term care services in Medicaid, one obvious obstacle is fiscal.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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