Post on 16-Dec-2015
www.nasuad.org
State Aging and Disability Policy: 50 years backwards, 50 years forward
John Michael Hall, Senior Director of Medicaid Policy & PlanningNASUAD
12/11/2013
Page 2
“Quotes—use quotes and other facts over images to create more visual interest, pauses and color fields.”
—Name, title
50 years of history of aging and disability policy
1970s—establishing the aging network
• Started congregate meal program – Served 200,000 meals– $100 million program
• Formed the Aging Network (AAAs)
Page 4
Arthur Flemming,
Commissioner on Aging
1980s -- Creating the Waiver
• Omnibus Reconciliation Act of 1981 created §1915(c) waiver, states were slow to take up the option in part because of the “cold bed” rule. Now, every state has some form of HCBS waiver.
• Permits states to provide HCBS to individuals who require the level of care provided in institutional settings.
• Most states have several HCBS waivers, different populations
• Often administered in different agencies
Page 5
2011—First Boomer turns 65
Source of charts: U.S. Census Bureau, “65+ in the United States: 2005,” December 2005.
2000 2020
9
Population 60+National
44,000,000
46,000,000
48,000,000
50,000,000
52,000,000
54,000,000
56,000,000
58,000,000
Population 60+ 49,788,075 50,697,360 52,499,373 54,120,116 55,748,172 57,424,771
2005 2006 2007 2008 2009 2010
2005 -2010
15.3% increase
HCBS Provisions in the ACA
• Balancing Incentive Program (BIP)
• Extending Money Follows the Person (MFP)
• Consumer First Choice -- §1915(k)
• Moving HCBS Into the Mainstream – State Plan Option §1915(i)
• Waiver Consolidation
• Health Homes
FUNDING FOR SENIORS
NOT KEEPING PACE NOW…
From 1980 to 2010
Page 17
60%POPULATION
INCREASEADULTS 65+
34%FUNDING
DECREASEAoA FUNDING
FUNDING FOR SENIORS
NOT KEEPING PACECurrent Funding Levels Unable
to Meet Increased Need
Page 18
$9.24PER
ADULTS 65+
1980 2010
$3.85PER
ADULTS 65+
FUNDING FOR SENIORS
NOT KEEPING PACEPercent of Seniors Continues to Grow
Page 19
20
10
ONE IN EIGHT ADULTS 65+
20
30
ADULTS 65+ONE IN FIVE
AGING SERVICES UNABLE
TO MEET DEMAND
If these trends continue millions will
be eligible, few will be served.
Page 21
1980 2010 2030 1980 2010 2030
MILLIONS OF SENIORS MILLIONS OF DOLLARS36 57 92 236 155 ???
AGING IN PLACE IS
COST EFFECTIVE
Annual Facility Care Cost
Page 22
$66,000MEDICAIDFINANCED NURSING FACILITY
$42,600PRIVATE PAY
ASSISTEDLIVING
$81,030PRIVATE PAY
NURSING FACILITY
AGING IN PLACE IS
COST EFFECTIVE
Annual Facility Care Cost
Page 23
$18,200-$20,800
HOMEMAKER & ADULT CARE
SERVICES
$24,675HOME &
COMMUNITY BASED MEDICAID
SERVICES
States Restructuring State Aging and Disability Agencies
AK
HI
OR
NV
UT
AZ
SD
NE
KS
AR
LA
WI
IN
KY
TN
GA
SC
VA
ME
MS AL
WV
CA
ID
MT
WY
NM
TX
ND
OK
MN
IA
MI
IL
MO
OH
FL
PA
NY
CO
NC
WA
VTNH
MA
MD
DE
NJ
DC
RI
States restructuring since 2011(CT, DE, HI, IA, IN, KS, ME, NC, NH, OH, OR, PA, VT, VA, WA, WY)
States with plans for restructuring (CO, DC, LA, NV, WV)
States both restructuring since 2011 and with plans (AL, MD, NJ)
CT
Factors Driving State Aging and Disability Agency Restructuring
0 5 10 15 20
Number of States
Comprehensive vision
Consistent policy making
Administrative simplification
Improved access to services (no wrong door)
Accountability
Quality management
Consolidation of program authority
Budget and personnel reductions
Preparation for managed long-term services and
supports
Other
Reduction of institutional bias
Global budgeting
Address functions that present conflict of interest
Medicaid Managed LTSS (MMLTSS)
Medicare-Medicaid Coordination Initiative
Both MMLTSS and Medicare-Medicaid Coordination Initiative
RI
AK
HI (W)
OR (W)**
NV UT
AZ (W)
SD
NE
KS
AR
LA
WI**
IN**
KY
TN (W)
GA
SC
VA*
ME
MS AL
WV CA*
ID
MT
WY
NM (W)
TX
ND
OK
MN (W)**
IA
MI
IL*
MO
OH*
FL**
PA
NY*
CO
NC
WA*
VTNH**
MA*
MD
DE NJ**
DC
RICT
* Financial Alignment (FA) demonstration proposal approved by CMS
** Initiatives other than FA demonstration (W) No longer pursuing FA demonstration
Medicaid Managed LTSS & Medicare-Medicaid Care Coordination Initiatives
(Current as of 10/3/2013)
Source: NASUAD State Medicaid Integration Tracker, September 2013 edition
RI
AK
HI
OR
NV
UT
AZ
SD
NE
KS
AR
LA
WI
IN
KY
TN
GA
SC
VA
ME
MS AL
WV CA
ID
MT
WY
NM
TX
ND
OK
MN
IA
MI
IL
MO
OH
FL
PA
NY
CO
NC
WA
VTNH
MA
MD
DE NJ
DC
RICT
Expanding Medicaid
Likely to Expand
Alternative Expansion Approved
Unlikely to Expand
Not Expanding
Medicaid Expansion (Current as of 10/3/2013)
Source: NASUAD Medicaid Expansion Tracker
RI
AK
HI
OR
NV
UT
AZ
SD
NE
KS
AR
LA
WI
IN
KY
TN
GA
SC
VA
ME
MS AL
WV CA
ID
MT
WY
NM
TX
ND
OK
MN
IA
MI
IL
MO
OH
FL
PA
NY
CO
NC
WA
VTNH
MA
MD
DE NJ
DC
RICT
More than One Activity
Balancing Incentive Program Only
Section 1915(i) State Plan Amendment Only
Section 1915(k) Community First Choice
Only
Health Homes Only
Other LTSS Activities(Current as of 10/3/2013)
Source: NASUAD State Medicaid Integration Tracker, September 2013 edition