ohio’s unified long-term care budget building a cost-effective, consumer friendly long-term...
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Ohio’s Unified Long-term Care Ohio’s Unified Long-term Care BudgetBudget
Building a Cost-Effective, Consumer Building a Cost-Effective, Consumer Friendly Friendly
Long-term Services & Supports Long-term Services & Supports SystemSystem
Ohio Department of Aging
Purpose
• To develop a comprehensive, flexible and transparent process for effective and efficient budgeting and service delivery that:– Encompasses both facility-based and home- and community-
based long-term services and supports
– Is based on consumer choice and differing levels of service need
– Includes a seamless array of service delivery options
– Features a consolidated policymaking and budget authority to simplify decision making and maximize the state’s flexibility
Ohio Department of Aging
Desired Outcomes - Consumers
• Consumers will be satisfied with the services they receive and experience a higher quality of life.
• Ohioans will be encouraged to plan ahead for future service and support needs, as well as be better prepared to make informed decisions about their options.
Ohio Department of Aging
Desired Outcomes - System
• A transparent budget for policymakers.
• A cost-effective system that links disparate
services across agencies and jurisdictions.
• Consistency in provider rate-setting.
• Accurate expenditure forecasts.
Ohio’s Unified Long-term Care Ohio’s Unified Long-term Care BudgetBudget
Building a Cost-Effective, Consumer Building a Cost-Effective, Consumer Friendly Friendly
Long-term Services & Supports Long-term Services & Supports SystemSystem
Promoting Flexible Funding Promoting Flexible Funding to Support Long Term to Support Long Term LivingLiving
SusanSusan C. ReinhardC. ReinhardDirectorDirectorAARP Public Policy InstituteAARP Public Policy Institute
Columbus, OhioAugust, 2007
GoalsGoals
Overview of Global/Unified Budgets
Important components that will lead to success
Specific State examples
Key indicators of success
Key ConceptsKey Concepts
Balancing LTC= Achieving more “parity” in funding community and institutional options so consumers have more “real choice”.
Set of Balancing Strategies, including increasing community capacity, informing people of options, funding/budgeting, nurse delegation and workforce, etc.
FinancingFinancingMoney Follows the Person = financing for
services and supports moves with the person to the most appropriate and preferred setting. – Global budgeting – Texas MFP– Deficit Reduction Omnibus Reconciliation Act
Rebalancing (Balancing) = reduced reliance on institutional options, increased community options.
Key ConceptsKey Concepts
Flexible Funding is essential but not sufficient force for change…….
Key Building BlocksKey Building Blocks
PERSONPhilosophy of self-direction and individual control in legislation,
policies, and practices
CommunityLife
Coherent Systems Management
AccessComprehensive information,
simplified eligibility, and single access points
FinancingA seamless funding system supporting individual choice
ServicesResponsive supports across settings and provider types
Quality ImprovementComprehensive systems that assure quality of life
and services
Budget StrategiesBudget Strategies
Money Follows the Person (MFP)
Planned Parity
Global Budget (Pooled Financing; Unified Budget)
MFP StrategyMFP Strategy Money Follows the Person = financing
for services and supports moves with the person to the most appropriate and preferred setting
Commonly starts from nursing home to HCBS--State example is Texas
Useful when long HCBS waiting lists and low occupancy in nursing homes
Indicators of Success Indicators of Success CMS Benchmarks CMS Benchmarks
Statutorily Mandated: Number of eligible individuals in each
target group of eligible individuals assisted in transitioning from an inpatient facility to a qualified residence each year.
Qualified expenditures for HCBS during each year of the demonstration program.
Indicators of Success Indicators of Success CMS Benchmarks CMS Benchmarks
Potential Additional Benchmarks– Percentage increase in HCBS versus
institutional long-term care expenditures under Medicaid.
– Utilization rates for a one-stop shops. – Flexible financing strategies, such as
global or pooled financing or other budget transfer strategies that allow “money to follow the person”.
Indicators of Success Indicators of Success CMS Benchmarks CMS Benchmarks
Potential Additional Benchmarks– Increases in available and accessible
supportive services (i.e., progress in achieving the full array of health care services for consumers, including the use of “one-time” transition services, purchase and adaptation of medical equipment, housing and transportation services beyond those used for MFP transition participants).
Planned Parity StrategyPlanned Parity Strategy Can be separate LTC budgets (nursing
home, HCBS); mandates reductions in nursing home budget and transfer of those savings to fund HCBS
Aggressive policy and program actions required (universal screening, level of care criteria, pre-admission processes, etc.)
Examples--Maine, Vermont in 1990s
Vermont: Systems ChangeVermont: Systems Change
Small state with steady drive to change
Total population = 608,823An aging state - 5th oldest in the
nationKnown for stakeholder meetings“Shifting the Balance” law led by a key
legislator (also a nursing home administrator)
Vermont Act 160Vermont Act 160
Shifted funds from nursing home to the HCBS appropriation
Goal 60-40% institution/communityStrategies: NF moratorium, expand
residential alternatives, one time investments
Five percent drop in NF supply
Act 160Act 160
“The reductions required … shall be redirected in FY 1997 to fund home and community-based services. For fiscal year 1998 and thereafter, the reductions required ... shall be redirected … to fund both home and community-based services and any programs designed to reduce the number of nursing home beds. Any general funds redirected but not spent during any fiscal year shall be transferred to the long-term care special administration fund...”
Department of Aging and IndependentLiving Services
Patrick Flood, VT DAILS
Vermont 1115 WaiverVermont 1115 Waiver
Provide maximum choice of services and settings
Eliminate institutional biasPromote early interventionBreak link between 1915 (c) waivers
and NF level of care
Goals for Vermont’s 1115 Goals for Vermont’s 1115 WaiverWaiver
Serve more people (within their cap)
Develop a more balanced LTC systemReduce NF useManage the LTC costs
Vermont’s PlanVermont’s Plan
Slow, incremental stepsBefore Choices for Care – waiting
lists and entitlementsNow: 3 Eligibility Groups
– Highest– High– Moderate
Nursing Facility
Home Based Waiver
Enhanced Residential Care Waiver
Below Nursing Home Level of Care
High
Low
Acu
ity
of N
eed Current
Eligibility threshold
CURRENT SYSTEM ELIGIBILITYCURRENT SYSTEM ELIGIBILITY
Choices for Care EligibilityChoices for Care Eligibility
Highest Need
Moderate Need Group
High
Low
Acu
ity
of N
eed Current &
Future Level of Care for Eligibility
Proposed Level for Entitlement Group
High Need Group
Choices for Care Eligibility Choices for Care Eligibility GroupsGroupsHighest, High, and Moderate Need
Groups
Highest Need GroupFunding for services is always availableConsumer chooses services at home,
Enhanced Residential Care Home, Assisted Living Residence, nursing facility or other approved location
Choices for Care Eligibility GroupsChoices for Care Eligibility Groups
High Need Group
Serve most, if not all, but enrollment depends on availability of funds
This group may access nursing facility care if funds are available.
Choices for Care Eligibility GroupsChoices for Care Eligibility Groups
Moderate Need Group
Not “nursing home level of care”
Preventive services, like Homemaker and Adult Day
Case management
Enrollment limited to available funds
Global BudgetGlobal BudgetConsolidating all of the components of
long term care spending into a single state agency budget – Funding can follow the person as they
move between services Placing the nursing facility, HCBS and
state-funded personal care programs and budgets into a single division
Global BudgetingGlobal Budgeting
Global Budgeting provides a budget appropriation format that allows LTC dollars to be used in the most cost-effective manner
Goal of Global BudgetingGoal of Global Budgeting
Move from a provider-based system to a consumer- based system– With appropriations attached to each
program provider to appropriations attached to each client
Individuals receiving supports drive resource allocation decisions, as they move through the long term care system– Milne, 2005
Global BudgetGlobal BudgetSet a total LTC spending budget based on
– projected LTC needs and preferences
– planned policy and program initiatives
Provide full administrative freedom to manage costs within the spending limit to respond quickly to consumer preferences
Global BudgetGlobal BudgetDoes not change nursing home
entitlement (unless 1115 waiver)
Does not entitle consumers to HCBS, but can help move in that direction
Works best if no waiting lists, but can help with nursing home transition efforts
Global Budget--State Global Budget--State ExamplesExamples
See Hendrickson & Reinhard, 2004
Oregon
Washington
New Jersey
Colorado
Oregon: A Pioneer with a Oregon: A Pioneer with a BlueprintBlueprintLegislature set forth philosophy of
Choice, Independence and Dignity in 1981
Serve more people and lower cost per case
Home and community care for private and public pay--stimulate the market, pay independent providers (including family members), allow nurses to delegate to paid “lay caregivers”
Oregon: A Pioneer with a Oregon: A Pioneer with a BlueprintBlueprintSingle entry access and
partnerships with local government, Board of Nursing, providers
Single state agency to administer Medicaid LTC, Older Americans Act and state funded programs
Foster prevention and primary health care
Washington: A PioneerWashington: A Pioneer
Legislature set forth philosophy ….establish a balanced range of health, social
and supportive services that deliver long term care services to chronically, functionally disabled persons of all ages and to ensure that services are provided in the most independent living situation consistent with individual needs” (Revised Code of Washington (RCW) §74.39.005) and “to the extent of available funding, the department shall expand cost effective options for home and community services for consumers” (RCW, 74.39A.030).
Washington….Washington…. ….The legislature further recognizes that
persons with functional disabilities should receive long-term care services that encourage individual dignity, autonomy, and development of their fullest human potential. (RCW 74.39.001)
The legislature further finds that the public interest would best be served by a broad array of long-term care services that support persons who need such services at home or in the community whenever practicable and that promote individual autonomy, dignity, and choice. (RCW 74.39A.005)
WashingtonWashington
• 1993 legislature approves relocation of 750 nursing home clients to HCBS
• 1995-1997 budget reduces NH caseload by 1,600 clients
• NH “bed need” assessment includes availability of home/community careAging and Disability Services Administration
WashingtonWashington
• Global Budget: Budget structure consolidated with significant management flexibility
• Caseload Forecasting Council projects NH & HCBS trends
Aging and Disability Services Administration
Washington Success: NF Washington Success: NF Caseload TrendsCaseload Trends
10000
11000
12000
13000
14000
15000
16000
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
NFFigures for July each year
Washington Success: HCBS Washington Success: HCBS TrendsTrends
22000
24000
26000
28000
30000
32000
34000
36000
38000
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
HCBS
Figures for July each year
Washington Success: LTC Spending Washington Success: LTC Spending TrendsTrends
0
200
400
600
800
1000
1200
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
NF spending HCBS NF @ 3% growth
Based on data from the Washington Aging and Disability Services Administration
WA: Shifting spending balanceWA: Shifting spending balance82%
2%
16%
49%
12%
39%
0%10%20%30%40%50%60%70%80%90%
NF Residential HOME
1991-1993 2003-2005
WA: Elders and Adults WA: Elders and Adults
26%20%
64%
0%
10%
20%
30%
40%
50%
60%
70%
NF Res Care Home
Caseload
•
New Jersey StrategyNew Jersey Strategy
Budget and Policy ConsolidationBudget and Policy Consolidation at at state level for older adultsstate level for older adults
Create more choicesCreate more choices for HCBS for HCBS servicesservices
Help consumers find choices easily Help consumers find choices easily through single entry point (through single entry point (NJ EASE)NJ EASE) and Community Choice Counseling and Community Choice Counseling ((nursing home transitionnursing home transition))
Long Term Care: You Decide Where!AARP Long Term Care Summit, March 23, 2004
AARP NJ 2004Social Impact
Agenda
1. $ Follows Person2. Fast Track Eligibility3. Global Budget4. Bill of Rights
Global Budgeting per 2004 and 2005 Executive Orders to “provide the Department of Health and Senior Services with the authority and flexibility — to move beneficiaries to the appropriate level of care based on their individual needs”
Parity legislation
Current NJ Policy and Current NJ Policy and Budget InitiativesBudget Initiatives
New Jersey SuccessNew Jersey Success
3,500 fewer Medicaid beneficiaries in nursing homes
10.4 % reduction in census, surpasses almost all states in recent years
Source: NJDHSS, Sept 15, 2004 Trenton, NJSource: NJDHSS, Sept 15, 2004 Trenton, NJ
30,000
30,500
31,000
31,500
32,000
32,500
33,000
33,500
34,000
Jan
-99
Mar
-99
May
-99
Jul-
99
Sep
-99
No
v-99
Jan
-00
Mar
-00
May
-00
Jul-
00
Sep
-00
No
v-00
Jan
-01
Mar
-01
May
-01
Jul-
01
Sep
-01
No
v-01
Jan
-02
Mar
-02
May
-02
Jul-
02
Sep
-02
No
v-02
Jan
-03
Mar
-03
May
-03
Jul-
03
Sep
-03
No
v-03
Service Month
NF
Cas
elo
ad
3,000
3,500
4,000
4,500
5,000
5,500
6,000
6,500
7,000
HC
BC
Cas
elo
ad
NF Caseload
HCBC Caseload
Linear (NF Caseload)
HCBC Growth = 0.7% per monthNF Growth =-0.2% per month
HCBC Growth = 2.3% per monthNF Growth =-0.1% per month
HCBC Growth = 0.8% per monthNF Growth =-0.2% per month
Global Budgeting:Global Budgeting:The Colorado ExperienceThe Colorado Experience
By Dann Milne, Ph.D.
Consultant
Ph: 303-399-6736
Vision for LTC --1990Vision for LTC --1990View Long Term Care as a SystemTo design a system to efficiently allocate
scarce resources for LTCA planned effort to reduce the growth in
Medicaid spending and to give clients choices of LTC services and settings
Administrative reorganization/consolidation removes: fragmentation of program authority, state budget process barriers, and program operations barriers
Before:Before:Appropriations were on a service by
service basis. Expenditures controlled for each program budget item– Administrative barrier was lack of budget
transfer authority– Agency could not overspend its HCBS
program budget, even if the nursing facility budget was decreasing
– Milne, 2005
After: Global Budget in 1991After: Global Budget in 1991
ne appropriation for all LTC services; by Elderly, SSI/Disabled, TANF, etc. eligibility categories– Automatically allows funds to follow
clients as they move from service to service as their needs and preferences change
Indicators of Success in Colorado Indicators of Success in Colorado Reduced the rate of growth in LTC
spending; saved 17% over projected LTC budget in 1994. Served 21% fewer in nursing facilities than projected. (Lewin Group study)
In 1996, began serving more clients in HCBS than in nursing facilities (cross-over point)
– Milne, 2005
Indicators of Success in Colorado Indicators of Success in Colorado
Spent 51.1% of LTC budget on HCBS in 2001, Ranked 5th in US (Profiles of LTC-2002, AARP)
Spent 32.7% of Elderly/Disabled LTC budget on HCBS, Ranked 8th is US in 2003
– Milne, 2005
Critical Elements to Support Critical Elements to Support TransformationTransformation Vision, Mission Leadership and Partnerships Access to multiple financing sources (Medicaid
HCBS & state plan, OAA, state general revenues) Streamlined financial and functional eligibility Comprehensive/single entry point
Strong quality management system, including information systems
What We Know About ChangeWhat We Know About Change
Not Easy
Not Fast
Worth it
Possible
Guiding PrinciplesGuiding PrinciplesChange DynamicsChange DynamicsDialogueDialogueConsensusConsensusCourageCouragePersistencePersistence
Ohio’s Unified Long-term Care Ohio’s Unified Long-term Care BudgetBudget
Building a Cost-Effective, Consumer Building a Cost-Effective, Consumer Friendly Friendly
Long-term Services & Supports Long-term Services & Supports SystemSystem
The Changing Face of Long-Term Care: Ohio’s Experience 1993-2005
Robert Applebaum
August 17, 2007 .
Scripps Gerontology Center
Miami University
Oxford, Ohio
Ohio Fast Facts… The population in Ohio who are most likely to need long-
term care (those over age 85) has increased by 55,000 (38%) over the last 12 years (1993-2005).
Despite the population increase the number of nursing home beds in service has been reduced from a high of 99,000 in 1997 to about 94,000 in 2005.
By 2050, there will be one million Ohioans over age 85. By 2020, Ohio will have more than 220,000 older people
with severe disabilities, almost 26% more than 2005. The number of residential care facility beds has increased
from 8,700 in 1993 to about 43,000 in 2005.
Estimated Number of Ohioans 60+ with Severe Disability
1993-2005
174,077175,876
154,300157,900
161,500165,100
168,683172,279
140,000
145,000
150,000
155,000
160,000
165,000
170,000
175,000
180,000
1993 1995 1997 1999 2001 2003 2004 2005
Year
Projections of Disability Among Ohio Population 2005-2020
Year Total Population Population with Some Disability
Population with Severe Disability
2005 11,464,042 789,115 304,511
2010 11,764,333 821,727 314,650
2015 11,960,864 837,860 329,419
2020 12,177,857 852,397 348,129
Estimated Disability Prevalence by Age, Ohio: 2005
0.50%
0.6%
0.9%
2.1%
3.8%
9.2%
23.1%
4.7%
7.3%
7.5%
11.2%
12.7%
17.6%
28.5%
0 5 10 15 20 25 30
0-14
15-24
25-44
45-59
60-69
70-79
80+
Age
Any Disability
Severe Disability
Residential Care Settings, 2.4
MR/DD Waivers, 5.5
Home and Community-Based Care Waivers, 11.1
Assisted Living, 4.5
ICF/MR, 1.9
Prisons, 1.3
Nursing Home, 22.5PACE, 0.3
Informal Care Plus Private Pay Home and Community-Based Care, 42.2
County Levies, 8.2
Estimated Proportion of Ohio's Population with Severe Disability in Different Long-Term Care Settings
Ohio Medicaid 2005
Ohio spent $11.5 billion on Medicaid.
Medicaid was 24% of Ohio’s annual budget.
42% of Ohio’s total Medicaid budget was spent on long-term care.
Ohio spent $2.6 billion on Medicaid nursing homes (ranks 9th) $1 billion on Medicaid ICF/MR facilities (ranks 5th).
Ohio spent $950 million on Home and Community Based Care Waivers (ranks 26th).
Ohio ranked 47th in home care/nursing home expenditure ratio.
Average Annual Cost per Person FY 2005, Includes Medicaid Card Costs
$2,491$8K $10K $12K
$22K
$44K $54K
$64K
$99K
$123K
$21,372
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000
ABDCFC
ODADAS
ABD Com
muni
ty
Men
tal H
ealth
PASSPORT
Home C
are
NF
MR W
aiver
ICF/M
R Priv
ate
ICF/M
R Pub
lic
Ohio Nursing Facility Admissions1992-2005
116,810
77,10790,693
30,359
190,150
168,924
70,879
120,015
149,905
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
1992 1996 2001 2003 2005
Medicare Resident
Total
More than 56% of all those admitted to nursing homes are no longer residents after 3 months; almost 7 in 10 are no longer residents after 6 months; by year end only one out of every 6 still there.
Short-Term Stay…
Cumulative Length of Stay as a Nursing Home Resident for a Cohort Admitted between Jul-Aug 2001,
and then Followed until June 30, 2004
5.7%
13.8%
10.3%
3.4%
5.5%
6.5%
3.0%
37.3%
20.2%
0% 5% 10% 15% 20% 25% 30% 35% 40%
1-20 days
21-100
101-120
4 to 6 months
6 to 9 months
9-12 months
1-2 years
2-3 years
more than 3 years
Proportion of Total & Medicaid Nursing Home Residents Still Living in a Facility
13.1
19.6
33.4
40.1
46.7
53.3
5.7
9.0
16.1
20.7
32.5
43.1
0%
10%
20%
30%
40%
50%
60%
0-3 Months At 6 Months At 9 Months At 12 Months At 24 Months At 36 Months
Medicaid
Total
Nursing Home Utilization in Ohio: 1993-2005
Adjusted Nursing
Facility Beds
Average Daily Census
Nursing Facility
Occupancy Rate (%)
1993 93,204 84,536 90.7
1995 96,579 86,728 89.8
1997 99,302 84,643 87.7
1999 95,701 79,216 83.5
2001 94,231 78,427 83.2
2003 90,712 76,850 84.7
2005 91,274 78,835 86.4
Average Daily Nursing Home Census 1993 to 2005
6,678 7,106 6,892 6,021
54,320 54,242 55,37752,158
23,409 23,295 21,415
21,037
4,481 5,211 5,930 6,548 7,325 9,200 10,062
55,079 56,199 54,70751,037 51,301
50,798 51,235
24,976 23,897 26,091
19,280 19,801 16,85217,538
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
100,000
1993 1994 1995 1996 1997 1998 1999 2000 2001 2003 2005
Medicaid
Medicare
84,536 85,307 86,72884,405 84,643
83,68479,910
76,86578,427
76,85078,835 Total
Private Pay
Over the Twelve Year Period (1993-2005)…
Occupancy rates dropped from 90.7% to 86.4%.
The average daily nursing home census dropped by 5,700 individuals per day.
The average daily Medicaid nursing home census dropped by 3,840 individuals per day.
The private pay average daily census dropped by 7,440, while daily Medicare Census has increased by 5,580.
Proportion of under 65 residents increased from 6.8% in 1994 to 14.1% in 2004.
Ohio’s nursing home residents are very impaired, &they are more disabled than they were 12 years ago.
8079797775
61616359 636767
62 65 68
0%10%20%30%40%50%60%70%80%90%
1992 1998 2001 2004 2006
% of residents with 4 or more ADL impairments% of residents with incontinence% of residents with cognitive impairment
PASSPORT: Ohio’s Major Medicaid Home & Community-Based Long-Term Care Services Program for 60+ Population
0
5,000
10,000
15,000
20,000
25,000
1993 1995 1997 1999 2001 2003 2005
Length of Stay as a PASSPORT Consumer as of September 30, 2005, in Years
38.9%
0.7%0.6%
1.1%
1.7%
2.2%
3.0%
4.8%
6.6%
8.6%
12.5%
19.3%
0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
Less than 1 year
2-3
4-5
6-7
8-9
10-11
Demographic Characteristics of Ohio’s PASSPORT Consumers:1994-2004
December 1994 (Percentages)
December 1999 (Percentages)
June 2004 (Percentages)
Average Age 77.7 76.0 76.0
Gender (Female) 80 80.7 79.8
Marital Status
Never Married 5.2 5.7 6.3
Widowed 59.8 56.9 51.4
Divorced/Separated 12.2 19.9 23.0
Married 20.8 17.5 19.3
Average cost of care plan per month
N/A N/A $1,050
Percent with active caregiver
N/A N/A 68.3
Number of consumers served
7,161 15,530 22,560
Functional Characteristics of Ohio’s PASSPORT Consumers: 2004 (Percentages)
Average number of ADL impairments (out of 6) 3.0
Average number of IADL impairments (out of 6) 5.0
Supervision needed
24 hour 8.1
Partial time 11.1
Incontinence 21.2
Number of prescribed medications
0 35.0
1 to2 2.4
3 to 5 9.4
6 to 10 26.8
11 to 15 17.9
16 or more 8.5
3.3%
21.6
29.2
19.4
14.0
6.6
2.0
1.0
0.6
0.5
1.8
0% 5% 10% 15% 20% 25% 30% 35%
< 1000
1,001 - 5,000
5,001 - 10,000
10,001 - 15,000
15,001 - 20,000
20,001 - 25,000
25,001 - 30,000
30,001 - 35,000
35,001 - 40,000
40,001 - 46,000
46,001 +
$ S
pe
nt
Distribution of 12 Month Service Plan Cost (Annualized)
PASSPORT consumers’ needs for assistance have remained relatively constant over the past twelve years.
3.03.0 3.0 3.0
4.95.1 5.25.0
0.0
1.0
2.0
3.0
4.0
5.0
6.0
1994 1999 2004 2006Average number of ADL impairmentsAverage number of IADL impairment
Reasons for Disenrollment from the PASSPORT Program
27.7
8.2
7.4
5.0
2.0
1.3
0.5
0.2
47.7
0% 10% 20% 30% 40% 50% 60%
Death
Admitted to nursing facility (30+ days)
Did not meet financial criteria
Consumer did not agree with care plan
Moved out of Ohio
Needs met by hospice
Admitted to hospital (30+ days)
Did not meet LOC criteria
Other
Source: PASSPORT consumers with an active service plan during October 1, 2004 to September 30, 2005. PASSPORT Information Management System (PIMS).
Average Per Diem for Nursing Home Residents in 2005 Dollars:1992-2005
164
310
162
116 135
167172163
153128
172
308288
120
305
$0
$50
$100
$150
$200
$250
$300
$350
1992 1998 2001 2003 2005
Per
Die
m
Medicaid- NH
Self Pay- NH
Medicare- NH
Medicaid PASSPORT & Nursing Home Annual Expenditures
Average annual PASSPORT expenditures per consumer were $15,590 ($2,280 of that was for assessment, administration & case management).
Average nursing home expenditures:
Age Group Average Daily NFExp.
Average Annual NF Exp.
60% of Average Annual NF Exp.
60 and Older
$133.99 $48,906.28
$29,343.76
Private Pay Nursing Home Residents Who "Spent-Down" to Medicaid, Over a Three Year Period (2001-2004)
22.632.3
54.6
64.1
12.14.20
10
20
30
40
50
60
70
80
90
100
0-3Months
At 6Months
At 9Months
At 12Months
At 24Months
At 36Months
Perc
ent o
n M
edica
id
Proportion of Nursing Home Residents Using Medicaid, Over a Three Year Period (2001-2004)
61.3
76.681.8
36.027.5
53.1
0
10
20
30
40
50
60
70
80
90
100
0-3Months
At 6Months
At 9Months
At 12Months
At 24Months
At 36Months
Perc
ent o
n M
edic
aid
Comparison of PASSPORT, Assisted Living, and Nursing Home Consumers (Demographic Characteristics)
PASSPORT Assisted Living Nursing HomeAverage Age 76.7 78 82.8 Gender Female 76.7 77.6 71.1 Race White 78.7 87.1 83.0
Marital Status Married 19.8 9.7 14.3
Comparison of PASSPORT, Assisted Living, and Nursing Home Consumers (Functional Characteristics)
PASSPORT Assisted Living Nursing HomeADL Bathing 96.0 94.0 91.6 Dressing 60.1 64.2 81.8 Eating 10.9 9.7 33.3 Toileting 21.1 35.1 76.3 Grooming 32.9 39.6 81.9
Number of ADL Impairments 0 0.8 0.0 7.2 1 3.5 6.0 7.2 2 34.5 20.1 4.7 3 33.6 25.4 5.7 4+ 27.5 48.5 75.3
Average Number of ADL Impairments 3.0 3.3 4.4
Incontinence 14.1 23.1 62.3
Distribution of Ohio's Medicaid Long-term CareUtilization by Setting: 1993-2005
816
21 23 2631 35
6569747779
8492
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1993 1995 1997 1999 2001 2003 2005
Nuring Home
PASSPORT
Number of Older Persons* Using Nursing Facilities or PASSPORT Services
30.8
20.819.5
18.0
21.3
2.9
10.911.8
12.911.4
0
5
10
15
20
25
30
35
1993 1999 2001 2003 2005
Medicaid Nursing Facility Residents
PASSPORT Consumers
*The number of persons are per 1,000 persons over age 60 in the population.
Ohio’s Unified Long-term Care Ohio’s Unified Long-term Care BudgetBudget
Building a Cost-Effective, Consumer Building a Cost-Effective, Consumer Friendly Friendly
Long-term Services & Supports Long-term Services & Supports SystemSystem
Ohio Department of Aging
The Process
• The Governor will appoint a workgroup.
• Legislative leadership will appoint four members of the General Assembly.
• The plan is to be completed by June 1, 2008, and must be submitted to the Joint Committee on Medicaid Technology and Reform.
• Seven subcommittees, building on existing efforts, will assist the workgroup.
Ohio Department of Aging
Decision Roadmap
• Who will be served by the long-term services and supports budget?
• What does “long-term services and supports” include?
Ohio Department of Aging
Questions for theSubcommittees
Ohio Department of Aging
“Front Door” Subcommittee
• What will be the design of the “front door” to long-term services and supports?
Ohio Department of Aging
Care Management Subcommittee
• What is the role of care management?
• Who benefits from care management?
• How will we interface with Medicare Special Needs Plans?
Ohio Department of Aging
Quality Subcommittee
• How will we incorporate the CMS “quality framework” into all aspects of long-term services and supports, including nursing facilities?
Ohio Department of Aging
“Unmet Needs” Subcommittee
• What unmet needs currently exist and what additional long-term services and supports should Ohio offer?
Ohio Department of Aging
Consumer Direction Subcommittee
• How will we incorporate the key principles of consumer direction into the system?
Ohio Department of Aging
IT Systems Subcommittee
• How will existing and planned IT systems be modified to accommodate a unified budget?
Ohio Department of Aging
Budgeting Subcommittee
• How will the budget be built and what model will be used?
Ohio Department of Ohio Department of AgingAging
1-800-266-43461-800-266-4346
[email protected]@age.state.oh.us
www.goldenbuckeye.com/ultcbwww.goldenbuckeye.com/ultcb