News, Notes, and Opinions from Michigan about the progress of choice-based long term care
Sunday, October 5, 2008
2007 Institution vs Community-Based Medicaid Services,
from Steve Gold:
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
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
Why the lopsided distribution based on type of disability?
Let's look at the differences in each State. The following chart provides
two 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
% of Medicaid Long Term Care expenditures for institutional services
versus community services.
National ...................36.9%/63.1% 69%/31%