Arkansas Health Care Reform Task Force – ID/DD Wait List

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Proprietary and Confidential

Arkansas Health Care Reform Task Force – ID/DD Wait ListExploring Options for Addressing the Wait List for the DDS Alternative Community Services (ACS) Waiver Program for the Intellectually Disabled and Developmentally Delayed

March 2016

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Executive Summary• TSG reports what a new waiver benefit would look like for the

2,640 people on the ID/DD wait list• Top-5 benefits except Supportive Living

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Agenda• Review historical spending for Waiver program• Report results of a survey of households on the wait list• Model the effect of alternative capped a range of alternative

waiver programs• Recommend path forward

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Waiver Background• Improve the quality of services through Home and Community

Based Waiver Services provided under a 1915 waiver for a limited number of individuals as an alternative to ICF/ID placement

• Serving targeted populations: mental illness, and intellectual, developmental or physical disabilities with an age of onset before age 22

• Participation capped at 3,9881, with turnover, served 4,127 different individuals in SFY2015

• Wait list of 2,640

1 - http://humanservices.arkansas.gov/ddds/waiverDocs/ACSWaiverGuidebook.pdf

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Services• Supportive Living – enable beneficiaries to live in their own

homes, with their family, or in an alternative residence • Respite Services – short-term benefits for beneficiaries unable

to care for themselves due to absence of non-paid caregivers• Supportive Employment – enable beneficiaries who need

intensive ongoing support to perform in a competitive work setting

• Adaptive Equipment – equipment to increase, maintain or improve functional capabilities to perform daily life tasks

• Vehicle Modifications – adaptations to an automobile or van to accommodate the special needs of the beneficiary

• Environmental Modifications – modifications made to or at the beneficiary’s home

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Services (cont.)• Specialized Medical Supplies – items necessary for life support

not otherwise available under Medicaid• Supplemental Support Service – enable community living, in

response to crisis, emergency or life threatening situations• Case Management Services – assistance in gaining access to

needed services, in or out of the Waiver• Consultation Services – clinical and therapeutic services• Crisis Intervention Services – in the beneficiary’s home or

other local community site by a mobile intervention team• Community Transition Services – set-up expenses for

beneficiaries who are transitioning from an institution

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SFY2015 Services by Claim Amount

0

25,000,000

50,000,000

75,000,000

100,000,000

125,000,000

150,000,000

175,000,000

200,000,000

225,000,000

Supportive Living

Waiver Spending by Service

Transition Respite Care Consultative Specialized Medical Supplies Adaptive EquipmentSupported Employ-ment Case Management Supportive Living

Claims data from SFY2015 federal Expenditures Report

0 - 10,000

20,000 - 30,000

40,000 - 50,000

60,000 - 70,000

80,000 - 90,000

10,0000 - 110,000

120,000 - 130,000

140,000 - 150,000

160,000 - 170,000

180,000 - 190,000

>200,0000

100

200

300

400

500

600

700

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%81%

Cummulative

100%

Spending Levels by Beneficiary

Annual Claims Amount by Beneficiary

Num

ber o

f Ben

eficia

ries

96% of Waiver Spending is for Supportive Living20% of beneficiaries spend less than $20,000 – 80% less than $70,000

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Spending by Service Type

Service Type

Total Waiver Claims

Amount

Unique Beneficiary

Count

Average for Those Claiming Benefit Percent

Supportive Living 196,404,211 4,013 48,979 95.9%

Case Management Services 5,550,856 4,094 1,357 2.7%

Supportive Employment 668,300 103 6,617 0.3%

Specialized Medical Supplies 642,407 925 696 0.3%

Consultation Services 453,751 733 621 0.2%

Adaptive Equipment -ACS 392,835 155 2,568 0.2%

Respite Services 380,605 153 2,521 0.2%

Environmental Modifications 238,010 52 4,760 0.1%

Supplemental Support Service 16,462 17 1,097 0.0%

Adaptive Equipment - PERS Monthly Fee 13,733 31 474 0.0%

Adaptive Equipment - PERS Installation 479 6 120 0.0%

Total 204,761,648 4,124 49,675 100.0%

Claims data from SFY2015

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Supportive Living Averages $49,000

0 to 10,000

10,000 to 20,000

20,000 to 30,000

30,000 to 40,000

40,000 to 50,000

50,000 to 60,000

60,000 to 70,000

70,000 to 80,000

80,000 to 90,000

90,000 to 10,0000

10,0000 to 110,000

110,000 to 120,000

120,000 to 130,000

130,000 to 140,000

140,000 to 150,000

150,000+0

100

200

300

400

500

600

0%10%20%30%40%50%60%70%80%90%100%82%

99%

Supportive Living

Frequency Cummulative

Total Waiver Claim Amount per Person -- SFY 2015

Num

ber o

f Ben

efici

arie

s

Cum

ulati

ve P

erce

nt o

f Ben

efici

arie

s


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Cost of Services Other Than Supportive Living

Case

Man

agem

ent S

ervi

ces

Supp

ortiv

e Em

ploy

men

t

Spec

ializ

ed M

edic

al S

uppl

ies

Cons

ulta

tion

Serv

ices

Adap

tive

Equi

pmen

t -AC

S

Resp

ite S

ervi

ces

Envi

ronm

enta

l Mod

ifica

tions

Supp

lem

enta

l Sup

port

Ser

vice

Adap

tive

Equi

pmen

t - P

ERS

Mon

thly

Fe

e

Adap

tive

Equi

pmen

t -PE

RS In

stal

latio

n0.01,000,000.02,000,000.03,000,000.04,000,000.05,000,000.06,000,000.0

0

2,000

4,000

6,000

1,357

6,617

696 621

2,568 2,521

4,760

1,097474 120

Historic Total and Average Costs of Services Other Than Living

Total Waiver Claims Amount Average for Those Claiming Benefit

Aver

age


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Services other than Supportive Living Rarely Total More than $6,000

0 to 1,000

1,000 to 2,000

2,000 to 3,000

3,000 to 4,000

4,000 to 5,000

5,000 to 6,000

6,000 to 7,000

7,000 to 8,000

8,000 to 9,000

9,000 to 10,000

10,000 to 11,000

11,000 to 12,000

12,000 to 13,000

13,000 to 14,000

14,000 to 15,000

15,000 +0

500

1,000

1,500

2,000

2,500

3,000

3,500

0%10%20%30%40%50%60%70%80%90%100%

77%90%

96% 99%

All Claims other than Supportive Living

Total Waiver Claim Amount per Person -- SFY 2015

Num

ber o

f Ben

efici

arie

s

Cum

ulati

ve P

erce

nt o

f Ben

efici

arie

s

A program capped at $6,000 would meet 96% of needs other than Living Support


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A Program Capped at as Little as $6,000 would Cover Most Historic Claims -- Except Supportive Living

02,0004,0006,0008,000

10,00012,00014,00016,00018,00020,00022,000

Spending by Current Waiver Beneficiary (Other than Supportive Living)

Individual Beneficiaries

Annu

al C

laim

s Am

ount

100%


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Agenda• Review current spending for Waiver program• Report results of a survey of households on the wait list• Model the effect of alternative capped a range of alternative


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Survey Method• Survey invitation sent by US mail to 2,640 individuals on the

wait list• Asked to rank the top 5 most important benefits from the list• Respondents responded by using a web survey• Asked for comments at the end of the survey• Offered the opportunity to respond anonymously or provide

detailed contact information• Respondents spent an average of 8 minutes responding (long

for a web-based survey). This suggests they took it seriously

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Responses Covered the State

Note: 81% of responses provided name and address, only these are graphed

• 440 responses in 10 days—17% response rate

• 81% provided addresses

• All but one provided a comment

• Responses represented the entire state

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How the Services were Ranked

Supporti

ve Li

ving

Respite Se

rvice

s

Case Management S

ervice

s

Supporti

ve Employm

ent

Environmental M

odifications

Consultation Se

rvice

s

Adaptive Equipment

Supplemental S

upport Se

rvice

Community Transiti

on Servi

ces

Specia

lized M

edical S

upplies

Vehicle M

odifications

Crisis I

ntervention Se

rvice

s0

50

100

150

200

250

300

350

400

450Services Ranking in the Survey

n=440

Rank 5

Rank 4

Rank 3

Rank 2

Rank 1

Num

ber o

f Res

pons

es

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Services by Rank

Rank 1 Rank 2 Rank 3 Rank 4 Rank 50

50

100

150

200

250

300

350

400

450Services Ranking in the Survey

n=440

Crisis Intervention ServicesVehicle ModificationsSpecialized Medical SuppliesCommunity Transition ServicesSupplemental Support ServiceAdaptive EquipmentConsultation ServicesEnvironmental ModificationsSupportive EmploymentCase Management ServicesRespite ServicesSupportive Living

Num

ber o

f Res

pons

es

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Summary Findings from Survey• Supportive Living is #1, but not as strongly favored as the 97%

of current Waiver participants that claim for Supportive Living • Respite and Case Management are clear #2&3 for those on

the wait list• Responses are widely dispersed—strongly supporting the

notion of self-determination of services• Response rate, and number, size and tone of comments all

suggest that the wait list is a very unhappy group, looking to the legislature for quick relief

• Respondents would rather have some benefits even if it is less that the whole Waiver program

• Respondents seek more self-direction• The selection process should be faster, clearer and more

transparent

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What if…• TSG has modeled a waiver like those in Indiana, Tennessee and

Kentucky. It would…• Provide a benefit capped at an amount much smaller that the

average of claims for those already on the Waiver• Allow recipients substantial latitude to spend up to the cap on

any of the services. Both models assume that for most beneficiaries, the capped amount would not be sufficient to fun a meaningful part of Supportive Living

• This model considered simply for the purpose of understanding what might result from such a capped benefit

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TSG Developed the Model Based On• Assumptions:• Services usage based on survey responses• Services cost based on historic Waiver claims• Assuming the program would allow beneficiaries to claim services

up to the cap• Excluding Supportive Housing from the value assessment, as we

know it averages $50,000, beyond other state caps• Seeking to find out:

1.What services would beneficiaries likely spend the capped amount on?

2.How far would the capped benefit go towards “buying” all of their 5 highest ranked services?

3.How much would the two scenarios cost in total, assuming 2,640 people came off the wait list into the new waiver program

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03,0006,0009,000

12,00015,00018,00021,00024,00027,00030,000

Simulated Beneficiary Claims

Rank 1 Rank 2 Rank 3 Rank 4 Rank 5

Annu

al E

stim

ated

Cla

ims

Self-Directed Benefit Simulation

72% of top-5 needs (other than Supportive Living) met by a cap of $12,00086% by a benefit capped at $15,000

The #4 & #5-ranked services are often the more expensive ones

72%

86%

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waiver programs: Next Task Force Update• Recommend path forward

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Full Cost of Capped Waiver for 2,640 on the ID/DD Wait List

Capped at $12,000

Capped at $15,000

Beneficiaries capped benefit: all services $31,680 MM $39,600 MMArkansas State Match Cost $9,504 MM $11,880 MM

Arkansas Health Care Reform Task Force – ID/DD Wait List

Government & Nonprofit

Transcript of Arkansas Health Care Reform Task Force – ID/DD Wait List