237316 Medicaid Long Term Care Home and Community Based Services: Trends in Programs and Policies, 1999-2008

Tuesday, November 1, 2011: 9:24 AM

Charlene Harrington, PhD , Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA
Terence Ng, MA, JD , Depratment of Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA
In response to consumer demand, the Supreme Court decision in the Olmstead case and the New Freedom Initiative, states have unevenly expanded combinations of three Medicaid home and community based services (HCBS) : home health, state plan personal care services (PCS), and 1915(c) waivers. By 2008, the federal-state Medicaid program paid for 44 percent of the nation's estimated $205 billion total long-term care (LTC) expenditures while institutional care (e.g., nursing homes) consumed 56 percent of those expenditures. As states struggle with budget deficits in FY 2010 and beyond, the Patient Protection and Affordability Care Act of 2010 and its provisions for continued HCBS growth reflects growing concerns about the need to preserve and expand Medicaid HCBS and the need for information on program and policy trends. This paper draws from a unique national dataset to present the latest trends in participants, expenditures and policies for the three Medicaid HCBS programs. While data for 2008 show a steady increase in participants and expenditures, these growth rates have slowed since 2001. Inequities in access to services and limited funds have also resulted in unmet needs for HCBS. Findings from the survey of policies such on the programs in 2010 show that states are increasing the number of waiting lists for waiver services even as the number of available “slots” increases. Cost caps such as service and cost limits are also used in almost half the state plan personal care programs and almost a third of home health programs.

Learning Areas:
Administration, management, leadership
Advocacy for health and health education
Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
: (1) identify trends in Medicaid HCBS participants, expenditures and policies, (2) understand state responses to unmet needs and fiscal crisis in terms of Medicaid program trends and policy, and (3) consider the potential impact on access to Medicaid HCBS through state policies

Keywords: Long-Term Care, Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am responsible for data collection and analysis for the research. My primary research interests focus on quality, access, utilization, and expenditures of nursing home care, home and community based care, and personal care services, as well as labor market issues. I am a fellow in the American Academy of Nursing, a member of the Institute of Medicine, widely published on Long Term Care and Personal Assistance Services, with over 200 published articles and books. I have served as the PI on numerous research studies on state long term care policies and program characteristics.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.