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State by State Medical Assistance FY 2012 LTSS Data for Aged and Disabled.
Information Bulletin #389 (May 2014)
For the past eleven years, we have tracked Medicaid funds by State by
comparing community versus institution expenditures for people with
disabilities. The FY 2012 data is now available. This Information
Bulletin will focus only on Older Adults and People with Physical
Disabilities from both a six year (FY 2007-2012) perspective with a more
detailed look at FY 2012.
It was reported that "Federal Fiscal Year (FFY) 2012 marked the second
consecutive year with little or no growth in national Medicaid spending
for long-term services and supports (LTSS) [which includes both
institutional and home and community-based services (HCBS)] Average annual
growth from FFY 2010 to FFY 2012 was 0.4 percent, compared to 6.2 percent
from FFY 2000 to FFY 2010."
Some good news: the "total LTSS spent on home and community-based
services (HCBS) increased from 48.7 percent in FFY 2011 to 49.5 percent in
2012. The shifting balance was attributable to both an increase in HCBS
spending of 2.4 percent and a decrease in spending for institutional
services of -2.3 percent."
However, this national average significantly "masks differences across
population groups. HCBS accounted for 70 percent of spending in programs
targeting people with developmental disabilities," but only "39 percent of
spending in programs targeting older people or people with physical
disabilities." That means for people with ID, only 30% of the entire MA
LTSS went to institutionalize people, but for people with A/PD 61% went to
nursing facilities.
Yes, once again the ID advocates and ID community continues to spend a
significantly higher percentage of their LTSS in the community and not
institutions, as compared to the PD/A advocates.
Focusing on the LTSS for people with physical disabilities, including aged
people with disabilities [yes, the "aged"] group is counted only if they
have a disability that would qualify for nursing facility care, there is
some encouraging data.
The "good" news is that in FY 2006, the national average of community
versus institutional Medicaid expenditures was 29.6% to the community and
70.4% to the nursing homes. In FY 2012, it was 38.8% to 61.2%. Yes, it's
a slow, incremental change. And yes, inherent in the lethargy and pace
are people being discriminated against in violation of the ADA. Without a
serious national attack, the arc of history will continue to bend, but
very, very slowly.
We all know why this imbalance is so slow to change: the nursing home
industry is very powerful and contributes a lot of money to Governors and
State legislators, and they set your State budgets. Given that most
people want to live in the community and not nursing homes, the quid pro
quo is obvious. The nursing home industry "contributes" to your elected
State officials, who in return continue to raise the per diem nursing home
reimbursements and continue to allocate Medicaid funds with an
institutional bias.
Unlike the for people with Developmental Disability, where 28 States spend
more than 75% of their Medicaid expenditures in the community and only 3
States spend less than 50% in the community, for the Older Americans and
People with Physical Disabilities no States spent more than 65% in the
community and 48 spent less than 50% in the community. Quite a
difference!
Here are the States that spent the least in the community in FY 2012 for
A/PD, and therefore spent the most in the nursing homes. The worst/least
Medicaid expenditures in the community was North Dakota, followed by
Kentucky, Alabama, New Jersey, South Dakota, Indiana, New Hampshire, Rhode
Island -- all spent less than 20% of their MA LTSS in the community for
people with A/PD, and by definition therefore spent more than 80% in
nursing homes.
Six of these "worst" A/PD states either have an exceptionally strong
nursing home industry or the State elected officials have a particular
dislike of Old Adults and People With Physical Disabilities. Compare
their community-based Medicaid expenditures for people with Developmental
Disabilities versus Older Adults and People with Physical Disabilities.
The following five states spent more than 70% of the Medicaid funds in the
community for people with DD, while spending less than 20% in the
community for people with A/PD: New Hampshire, Alabama, Rhode Island,
South Dakota and Kentucky. Quite a difference!
Here are the States that spent the most in the community in FY 2012 for
A/PD, and therefore spent the least in the nursing homes: Minnesota,
Alaska, Washington, Oregon, California, District of Columbia, Texas and
Wisconsin. These States are the winners -- virtually the same as in 2011.
What are advocates in these States doing right? Tell us.
Advocates for Older Adults and people with Physical Disabilities should
sit down in your State with the advocates for people with Developmental
Disabilities to discuss their successful strategies.
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.
Information Bulletins will also be posted on my blog located at
http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to
[email protected]
or call 215-627-7100. Ext 227.
--
Steve Gold, The Disability Odyssey continues
Back issues of other Information Bulletins are available online at
http://www.stevegoldada.com
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Subject: State by State Medical Assistance FY 2012 LTSS Data for Aged
and Disabled.
From: Steve Gold <[email protected]>
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State by State Medical Assistance FY 2012 LTSS Data for Aged and Disabled.
Information Bulletin #389 (May 2014)
For the past eleven years, we have tracked Medicaid funds by State by
comparing community versus institution expenditures for people with
disabilities. The FY 2012 data is now available. This Information
Bulletin will focus only on Older Adults and People with Physical
Disabilities from both a six year (FY 2007-2012) perspective with a more
detailed look at FY 2012.
It was reported that "Federal Fiscal Year (FFY) 2012 marked the second
consecutive year with little or no growth in national Medicaid spending
for long-term services and supports (LTSS) [which includes both
institutional and home and community-based services (HCBS)] Average annual
growth from FFY 2010 to FFY 2012 was 0.4 percent, compared to 6.2 percent
from FFY 2000 to FFY 2010."
Some good news: the "total LTSS spent on home and community-based
services (HCBS) increased from 48.7 percent in FFY 2011 to 49.5 percent in
2012. The shifting balance was attributable to both an increase in HCBS
spending of 2.4 percent and a decrease in spending for institutional
services of -2.3 percent."
However, this national average significantly "masks differences across
population groups. HCBS accounted for 70 percent of spending in programs
targeting people with developmental disabilities," but only "39 percent of
spending in programs targeting older people or people with physical
disabilities." That means for people with ID, only 30% of the entire MA
LTSS went to institutionalize people, but for people with A/PD 61% went to
nursing facilities.
Yes, once again the ID advocates and ID community continues to spend a
significantly higher percentage of their LTSS in the community and not
institutions, as compared to the PD/A advocates.
Focusing on the LTSS for people with physical disabilities, including aged
people with disabilities [yes, the "aged"] group is counted only if they
have a disability that would qualify for nursing facility care, there is
some encouraging data.
The "good" news is that in FY 2006, the national average of community
versus institutional Medicaid expenditures was 29.6% to the community and
70.4% to the nursing homes. In FY 2012, it was 38.8% to 61.2%. Yes, it's
a slow, incremental change. And yes, inherent in the lethargy and pace
are people being discriminated against in violation of the ADA. Without a
serious national attack, the arc of history will continue to bend, but
very, very slowly.
We all know why this imbalance is so slow to change: the nursing home
industry is very powerful and contributes a lot of money to Governors and
State legislators, and they set your State budgets. Given that most
people want to live in the community and not nursing homes, the quid pro
quo is obvious. The nursing home industry "contributes" to your elected
State officials, who in return continue to raise the per diem nursing home
reimbursements and continue to allocate Medicaid funds with an
institutional bias.
Unlike the for people with Developmental Disability, where 28 States spend
more than 75% of their Medicaid expenditures in the community and only 3
States spend less than 50% in the community, for the Older Americans and
People with Physical Disabilities no States spent more than 65% in the
community and 48 spent less than 50% in the community. Quite a
difference!
Here are the States that spent the least in the community in FY 2012 for
A/PD, and therefore spent the most in the nursing homes. The worst/least
Medicaid expenditures in the community was North Dakota, followed by
Kentucky, Alabama, New Jersey, South Dakota, Indiana, New Hampshire, Rhode
Island -- all spent less than 20% of their MA LTSS in the community for
people with A/PD, and by definition therefore spent more than 80% in
nursing homes.
Six of these "worst" A/PD states either have an exceptionally strong
nursing home industry or the State elected officials have a particular
dislike of Old Adults and People With Physical Disabilities. Compare
their community-based Medicaid expenditures for people with Developmental
Disabilities versus Older Adults and People with Physical Disabilities.
The following five states spent more than 70% of the Medicaid funds in the
community for people with DD, while spending less than 20% in the
community for people with A/PD: New Hampshire, Alabama, Rhode Island,
South Dakota and Kentucky. Quite a difference!
Here are the States that spent the most in the community in FY 2012 for
A/PD, and therefore spent the least in the nursing homes: Minnesota,
Alaska, Washington, Oregon, California, District of Columbia, Texas and
Wisconsin. These States are the winners -- virtually the same as in 2011.
What are advocates in these States doing right? Tell us.
Advocates for Older Adults and people with Physical Disabilities should
sit down in your State with the advocates for people with Developmental
Disabilities to discuss their successful strategies.
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.
Information Bulletins will also be posted on my blog located at
http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to
[email protected]
or call 215-627-7100. Ext 227.
--
Steve Gold, The Disability Odyssey continues
Back issues of other Information Bulletins are available online at
http://www.stevegoldada.com
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