AARP Report Details LTSS Utilization in the Great Recession
July 26, 2013 02:07 PM
On July 16, 2013, AARP released a report entitled At the Crossroads: Providing Long-Term Services and Supports at a Time of High Demand and Fiscal Constraint (the Report). The National Council on Medicaid Home Care, a NAHC affiliate, analyzes the Report’s major Medicaid-related findings.
Poor Economic Factors Threaten LTSS Utilization
The Report highlighted several economic trends that pose a threat to Medicaid LTSS utilization: 1) sixteen states project below 2007-level tax revenues for 2013; 2) many states, especially in the South and West, have not seen pre-recession tax revenues; and 3) states are continuing to cut staff.
For details, see pages 4-9, here.
HCBS Waivers and Expenditures Projected to Increase
According to the Report, 36 out of the 47 states that responded stated that HCBS waiver recipients increased from 2011 to 2012, and 34 out of the 47 states projected the same for 2012 to 2013. Out of the 44 states that responded, 34 stated that HCBS expenditures increased from 2011 to 2012, with 37 projecting the same for 2012 to 2013.
For details, see pages 10-12, here.
Nursing Facility Population is Decreasing or Remaining Flat
In most states, the Medicaid nursing facility population is either decreasing or remaining stable. However, 28 percent of the states surveyed did report an increase in this population in 2012.
For details, see pages 12-13, here.
States are Adopting the ACA’s HCBS Options
The Affordable Care Act (ACA) created or amended several HCBS options, including: health homes, improved care coordination for dually eligible individuals (Duals Coordination), Section 1915(i) Medicaid State Plan Amendment (1915(i) Amendment), Balancing Incentive Program (BIP), and Community First Choice Option (CFC). Over 30 states are at least implementing health homes, 34 states are have or plan to implement Duals Coordination, 22 states are at least considering 1915(i) Amendments, 19 states are at least considering BIP, and 16 states are at least considering CFC. For the full details, see page 21 and 24-29, here.
Duals Coordination Dominated by Managed Care
Twenty five out of the 33 states that described their duals coordination initiatives stated that they are adopting a risk-based managed care (RBMC) model, with only seven states adopting a managed fee-for-service (MFFS) or primary care case management (PCCM) model, and one describing an accountable care organization (ACO) model. Rhode Island and Washington are implementing a hybrid RBMC/MFFS model.
For details, see page 21-23, here.
To see a Council article on an April AARP study on duals and on which the Report’s findings are based, click here.
States are undergoing cost containment strategies at a time where LTSS demands are on the rise. In part to reduce costs, states have been moving towards RBMC models and emphasizing integration of care for dual eligibles. Home care providers should continue to advocate for greater LTSS and HCBS - not only has demand for these services increased, but the current economic reality creates an opportune time for greater implementation of cost-effective HCBS models over institutionalization.
Home care providers should continue to monitor developments in their states, and contact the Council with questions or concerns.