The Generations Project

Working to inform, educate, organize, and

offer creative solutions to rebalance Indiana’s long

term care system

Established in 2001

Collaborating Partners

AARP Indiana Alzheimer’s Association The Arc of Indiana Citizens Action Coalition of

Indiana CICOA, Aging & In-Home

Solutions

COVOH - Council of Volunteers and Organizations for Hoosiers with Disabilities

Indiana Alliance for Retired Americans

Indiana Association of Area Agencies on Aging

Mental Health Association in Indiana

United Senior Action of Indiana.

The Issue

Rebalancing Indiana’s public spending for long term care: Medicaid

Balancing spending on home and community-based services with spending on institutional care.

Quality of Life Issue Wise use of public money Providing services that are preferred

Critical Constituencies

Seniors Persons with

disabilities Minorities Service Clubs Neighborhood &

senior centers

Labor & retirees Business

organizations Academia Local

Neighborhoods Faith-based

organizations

Progress

Spring 2003:– Passage and signing into law of Senate

Enrolled Act 493

Spring 2004:– Little or no progress on behalf of state to

implement the law. Delays, excuses.

Long Term Care

Rebalancing Indiana’s Long Term Care System

June Holt, Outreach Coordinator The Generations Project

Long Term Care

What is long term care? Who needs long term care? Where do people prefer to receive LTC? Who pays for LTC? Why should we be concerned about long

term care?

Defining Long-Term Care

Long term care encompasses a broad range of help with daily activities that chronically disabled individuals need for a prolonged period of time– Primarily low-tech services– Assistance with ADLs and IADLs– Hands-on or supervisory human assistance– Assistive devices– Home modifications

Definitions

What are they talking about?

or

Some terms you should know.

CHOICE Program

Community & Home Options to Institutional Care for the Elderly & Disabled

Totally funded by state of Indiana Served 10,000 in 1999 Model program for home care

HCBS = Home & Community Based Services

Medicaid Waivers

Allow Indiana to provide a variety of in-home and community-based services to individuals who would otherwise require the level of care provided in an institutional setting

Each client is assigned to a “waiver slot”– One can not receive services unless assigned to

a waiver slot Served 7,615 in FY 2002

SSISupplemental Security Income

Pays monthly benefits to the poor who are blind, disabled or elderly.

2003 SSI:– $552/month for individual

300% SSI = $1656

Used as a qualifying amount for Medicaid services

SEA 493:Long Term Care Reform Act

2003 Senate Bill 493 A bill designed to rebalance the way Indiana spends

Medicaid dollars on long term care. Passed without a negative vote by Indiana House

and Senate Senate Enrolled Act 493: SEA 493 Signed into law in May 2003 Public Law 274-2003 IC 12-10-11.5

Institution or Home?

System is out of balance

2002 Medicaid funds Indiana spent $1.1 billion on institutional care Indiana spent $194 million for home and

community based care HCBC costs taxpayers 65-80% less than

institutional care

$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

All home & community based care Nursing homes

Annual tax dollars in millions spent on long term care in Indiana (2001/2002)

$1.174 billion

$194 million

Indiana long term care costs

Average per person per year cost for home and community based care vs

nursing home care, 2002

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

CHOICE Program Nursing Home

Spending on Home & Community Based Care

vs Institutional Care

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

Indiana Wisconsin Washington Oregon

HCBC Institutions

Balanced spending in other states

Hoosiers prefer home care

More than 27,000 on waiting lists for HCBC– Many qualify for NH bed but don’t want to go

Many empty nursing home beds– In 2001 nearly 25% of nursing homes were empty

#1 reason to get off waiting list is death

#2 reason is going into nursing home

Why has this happened?

Used to think NH or institutional care was best for the disabled – young or old

Laws written with “Institutional Bias”– Mandated NH/institutional care

These laws have created barriers for low income Hoosiers to receive HCBC

Laws force many into nursing homes who would be better served at home

SEA 493: The Law

Rebalances the way public money (Medicaid) is

spent on long term care

Eliminates barriers

Allows Medicaid dollars to follow the client from nursing homes to home care.

Makes the income eligibility standard for Medicaid home care services the same as for nursing home care at 300% of SSI.

Directs the state to apply for an additional 20,000 Medicaid waiver slots.

Supports families

Protects the spouse from becoming impoverished when services are provided at home.

Establishes a caretaker support program.

Expands services to include personal care services and more.

Respects the person

Expands client rights under Medicaid waivers.

Establishes the right to self-directed care.

Establishes a comprehensive array of home and community based services.

Provides for future needs

Indiana must establish a system of integrated services to facilitate Home and Community-based care including:

– Improved transportation, – More choices in housing– Enhanced education – Expanded workforce development

Implementation of the Law

Indiana is slow in implementing this law

Waiting lists are too large and are growing

People are dying instead of getting the care they need and deserve.

2004 Legislation

Passed Senate Bill 449

Gives Health Finance Commission (Joint Senate & House committee) the charge to monitor implementation of SEA 493

Will allow legislators to follow the implementation process of SEA 493

Opportunities for Hoosiers

Keep the issue alive until the law is working for us

Let the governor and your legislators know that you want this law to be implemented as quickly as possible

SEA 493 will save lives and save money

Questions, Discussion & Action

Call the Governor at

317-232-4567 orE-mail at jkernan@state.in.us

1. Ask him to implement SEA 493, the Long Term Care Reform Act of 2003

2. It’s good for taxpayers, it’s good for the state and it’s what Hoosiers want

Rebalancing Indiana’s Long-term Care SystemSEA 493: It’s the law!

Thank You