AARP Study Finds Older Americans Not Getting
Medicaid LTC at Home Where They Want It
Only four states spending more than 50% of Medicaid
dollars on seniors for home, community services
Medicaid Long-Term Care Spending for Older People and Adults
with Physical Disabilities in U.S. in 2006 - AARP
July 14, 2008 – Surveys show that the vast majority
of senior citizens prefer to receive long-term care in their homes,
rather than in an institution, but that is not how most states are
allocating their Medicaid dollars, according to a recent report by
AARP’s Public Policy Institute. Only four states spent more than 50
percent of their Medicaid LTC dollars for older people to provide home
and community based services (HCBS).
The report finds promising signs and mixed results
among state government efforts to balance LTC options under Medicaid,
although, all but these four states continue to spend the majority of
their Medicaid LTC dollars for the elderly on institutional care, such
as nursing homes.
The report, A Balancing Act: State Long-Term
Care Reform, is the first to examine Medicaid spending on long-term
care for older people and adults with physical disabilities, separate
from other LTC users such as people with mental
retardation/developmental disabilities (MR/DD).
Nationally, 75 percent of Medicaid LTC spending for
older people and adults with physical disabilities pays for
institutional care in nursing homes. In contrast, states have done a
much better job balancing Medicaid LTC for people with MR/DD, spending
just 39 percent on institutional care. The majority of funds now
supports people in home and community-based settings.
“What states have accomplished for people with
mental retardation/developmental disabilities is remarkable,” said Susan
Reinhard, Senior Vice President AARP Public Policy Institute. “It proves
that balancing long–term care is achievable and should be used as a
model to help states provide home and community based services for older
adults.”
Medicaid’s bias remains a major barrier to leveling
the playing field between options for institutional care and HCBS for
older adults, according to the report. Medicaid is required to provide
nursing home care for older adults who are impoverished and require
care, but is not required to provide HCBS.
“This is backwards. People are entitled to costly
nursing home care, but not to often more cost- effective services in
their homes. Clearly home and community-based services are preferred by
older residents,” said Reinhard.
“Our research shows that older people want to
remain in their homes as they age. They want independence, choice and
control over every day decisions. However, public funds continue to
steer older people into institutions.”
Also highlighted in the report are best practices
from states that are making progress balancing LTC options. Alaska,
Oregon, Washington and New Mexico spent more than 50 percent of their
Medicaid LTC budget for older people and adults with physical
disabilities in 2006 on HCBS.
These states embraced a philosophy of delivering
services in a way that allowed older people the greatest independence.
The ability of some states to accomplish substantial reforms for older
people and adults with physical disabilities – as well as increased HCBS
options for MR/DD – demonstrates that obstacles to balancing LTC options
can be overcome.
The report examines Medicaid LTC funding because it
is the primary payer for LTC in the country. It found that balancing
Medicaid LTC options will require a commitment from state officials and
cooperation from federal authorities. HCBS can be both cost-effective
and responsive to the preferences of older people and adults with
disabilities.
“This underscores the need for better government
and private sector financing options for long-term care. Americans have
few options to plan and pay for their long-term care. Medicare provides
only modest funding for a limited number of services and Medicaid’s
stringent financial eligibility criteria require most people to become
impoverished to qualify. It is clear that we must eliminate Medicaid’s
persistent bias towards costly and undesired institutional care, and we
need to advocate for more affordable long-term care financing options.
Government, individuals and the private sector all have a role to play,”
said Reinhard.
The new report includes state rankings and can be
found by
clicking here.
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