237326 Institutional and Community-Based Long-Term Care: A Comparative Estimate of Costs

Tuesday, November 1, 2011: 9:06 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
As long-term care policy makers struggle with competing challenges including state budget deficits and pressures to expand home and community-based services (HCBS), there is a pressing need for information on the comparative cost of Medicaid HCBS and institutional care. This paper uses the most recent available data (2008) to present three per participant expenditure comparisons between Medicaid HCBS waivers (which require that participants have an institutional level of care need) and institutional care: 1) program expenditure (waivers vs. the comparable level of institutional provision); (2) total Medicaid expenditure (program plus other Medicaid expenditure); and (3) estimated total public expenditure (Medicaid expenditures plus state and federal supplemental income payments). Additional estimates are produced for different waiver target populations (e.g., elderly/disabled and physically disabled) and for the different levels of care offered by waivers (e.g., nursing facility and ICF/MR). This analysis estimates that when compared with Medicaid institutional care in 2008, HCBS waivers produced a national average public expenditure saving of more than $58,000 per participant. When multiplied by total waiver participants, this gives an estimated annual saving of almost $60 billion.

Learning Areas:
Administration, management, leadership
Advocacy for health and health education
Biostatistics, economics
Chronic disease management and prevention
Public health or related organizational policy, standards, or other guidelines
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
From this session participants will be able to identify cost savings due to the workings of the Medicaid HCBS waiver program.

Keywords: Cost Issues, Long-Term Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a co-author on this research study. 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.