NAHC’s Medicaid Council Reports on MACPAC Public Meeting
December 6, 2013 01:47 PM
On November 14, the National Council on Medicaid Home Care – a NAHC affiliate – sent Resource Director Steve Postal to attend the most recent MACPAC Public Meeting held in the Ronald Reagan Building and International Trade Center in Washington, DC titled “Long-Term Care Commission: Report from the Commission’s Leadership.” The meeting was led by Commission members Bruce Chernof, President & CEO of the SCAN Foundation, and Mark Warshawsky, Adjust Scholar at the American Enterprise Institute.
Overview. For the first half of the hour-long meeting, Mr. Chernof read through a slide deck highlighting the summary of the Commission’s final report to Congress. The presentation focused on an overview of the Commission’s charge and activity, as well as its recommendations regarding service delivery, workforce, and financing. A previous Council article on the Commission report, with a synopsis of the material relevant to Medicaid and/or home and community-based services (HCBS), can be found here. For the second half of the meeting, the two Commissioners fielded questions. Findings not previously addressed by the Council are found below.
Importance of uniform assessment tool. One recurring theme in the meeting was the importance of a uniform assessment tool to determine LTSS eligibility and generate a single plan of care. One such uniform assessment tool has been recently approved in Oregon for the state’s developmentally disabled population. The Commissioners had “true consensus” on the issue of a uniform assessment tool, and recognized its importance to financial integration and savings. Mr. Chernof stated that CMS has been spending a lot of time developing this assessment, but to date it has not been launched. Mr. Warshawsky chided CMS for “limping along” with this issue “for decades.” In addition, Mr. Chernof stressed the importance of having family caregivers enfranchised in the creation of the beneficiary’s needs assessment and plan of care.
Commission suggests Medicaid LTSS demonstration to promote employment in disabled community. Mr. Chernof briefly mentioned the need for the government to create a new demonstration to provide LTSS to the disabled, working population, with the intention of helping them to remain employed. See page 62 of the Commission’s report, here, for details.
LTSS is for varied populations. Mr. Chernof also stressed that while the traditional conception of LTSS is for the elderly and retiree population, as that is from where most data is being collected, it is important to note that LTSS is also for eligible disabled and pediatric populations as well. He called on stakeholders to invest in data gathering with regard to these populations.
Financing agreement not reached due to time constraints, desire for broader consensus. Mr. Chernof explained that the primary reasons that a financing mechanism was not agreed on in the final report was because of time constraints, namely for the Congressional Budget Office (CBO) to score any hypothetical budget proposals. Further, the members of the Commission were not prepared to discuss financials, as they lacked sufficient data, and only Mr. Warshawsky is a health economist. The Commission also did not discuss a federal vs. state emphasis on financing as they wanted to reach a broader agreement in the Report. Mr. Chernof stated that it was evident that “home and community based services should be prioritized above nursing homes, period,” but there was difference in opinion from conservative and progressive viewpoints as to how to accomplish this goal.
Housing benefits not discussed due to time constraints. Mr. Warshawsky also discussed that the Commission did not discuss instituting a housing benefit as a supplement to LTSS due to time constraints.
The presentation’s utilization graphics. Mr. Chernof’s presentation included several utilization graphics worth noting. The slide deck can be found here (click on the slide deck of “Summary of Final Report of the Long-Term Care Commission.” On slide 8, Mr. Chernof broke down populations needing long term services and supports (LTSS) using 2010 and 2012 data; with 0.6 million children, 5.4 million working age adults, and 6.7 million elderly needing LTSS. This graph also shows that the majority of these populations need LTSS via high, medium, and low-need community care, rather than institutionalization. On slide 10, Mr. Chernof broke down LTSS expenditures by source in 2011, with Medicaid, at $131.4 billion, providing the majority (62.3%) of expenditures. Finally, on page 16, Mr. Chernof gave a projection that the number of Americans that will need LTSS will more than double from 2010 figures (12 million) to 2050 (27 million).
Home care providers are encouraged to keep abreast of developments arising from the Commission’s report, and to contact the Council with any questions or concerns.