Disability Action Center NW, Inc.

Community-Based LTC - A Comparison, Information Bulletin # 89 (7/05)

The Disability Odyssey continues
By Steve Gold
Link to Article

For the first time, the FY 2004 Medicaid expenditures compare community based long-term care ("LTC") expenditures by State and by category. What follows is a breakdown and comparison by State.

LTC expenditures are made up of two categories - institutional versus community MA expenditures. For each, there are also two separate subcategories: (1) the MR/DD institutional services include ICF/MR, and the MR/DD community services are MA waivers; (2) for the physically disabled/aged disabled ("PD/AD"), the institutional services are nursing facilities, and their community based services include waivers, personal care option and home health services.

The organized MR/DD community efforts began years before the PD/AD efforts. As a result, in the same States, the MR/DD category has much higher percentages of MA LTC funds expended in the community than for PD/AD. But the differences are quite stark and offer a great opportunity to equalize the expenditures.

Obviously, the higher the percentages in the community, the more integrated the services. While the MR/DD community deserves loud kudos, the PD/AD communities should ask their Governors to increase the PD/AD percentages in the community to provide equal opportunity to reside in the community.

It is very important to remember that whatever the percentage is for the community-based expenditure, your State is spending the remainder (up to 100%) on institutional services.

What is striking is that only seven states spend more than 50% of their TOTAL LTC (i.e., both MR/DD and PD/AD) on community-based services as opposed to institutional services. However, when one examines only the MR/DD community-based services, then 36 states spend more than 50% of their MR/DD funds in the community; when one examines only AD/PD only 3 States spend more than 50% of their PD/AD community-based services - and 47 States spend more to institutionalize persons with PD/AD than they spend to serve these people in the communities.

Following is a breakdown by State. The first chart is the percentage of Total community-based LTC expenditures - that includes BOTH the MR/DD and the PD/AD. The second chart is the percentage of community-based expenditures for ONLY the MR/DD and the third chart is the percentage of community-based for ONLY the PD/AD. Thus, you can compare how well your State is doing overall with regard to community-based expenditures and also how well it is doing in each of the two categories.

#1 BOTH MR/DD AND PD/AD Community LTC - National Average 35.5%

Oregon 70.5% of total LTC in the community; N. Mexico 67.6%; Alaska 62.1%; Vermont 57.7%; Minnesota 55. 9; Washington 54.7; Wyoming 53.4;

THE FOLLOWING SPEND LESS THAN 50% IN THE COMMUNITY

Colorado 48.5; Maine 46.9; Kansas 46.9; California 44.6; New York 43.4; Rhode Island 42.1; Utah 41.3; Idaho 40.8; Wisconsin 39.4; West Virginia 38.8; North Carolina 38.8; New Hampshire 38.2; Maryland 37.7; Connecticut 37.4; South Dakota 37.0; Oklahoma 36.8; Hawaii 36.3; Texas 36.0; Montana 35.8; Missouri 35.5; Massachusetts 35.4; Nebraska 31.8; Virginia 31.7; New Jersey 31.6; Iowa 31.1; S. Carolina 30.6; Nevada 30.1; Kentucky 29.7; Delaware 29.0; Michigan 28.2; Indiana 26.7; Illinois 26.6; Florida 26.0; Alabama 25.4; Arizona 25.1; Georgia 24.7; N. Dakota 22.5; Louisiana 22.4; Pennsylvania 22.3; Ohio 21.6; Arkansas 21.5; Tennessee 17.3; Washington DC 11.7; Mississippi 5.2;

United States 35.5%

#2 ONLY MD/DD Community LTC Expenditures-

National Average 57.6%

Alaska 100% of MR/DD expenditures in the community; Oregon 100%; Vermont 99.1%; New Hampshire 98.2; Rhode Island 96.0; Michigan 95.3; Hawaii 89.9; New Mexico 89.8; Maryland 85.1; Colorado 84.4; Alabama 82.8; Minnesota 81.8; Wyoming 81.0; South Dakota 78.3; Maine 76.4; Kansas 74.5; Montana 74.3; West Virginia 73.1; Massachusetts 70.9; Washington 69.4; Pennsylvania 66.5; Florida 65.9; Georgia 65.3; Nebraska 65.2; Connecticut 64.4; Oklahoma 64.4; Delaware 64.2; Wisconsin 63.5; Utah 63.3; California 60.2; Kentucky 56.2; New York 55.8; Virginia 54.7; Tennessee 52.6; Indiana 51.7; Missouri 51.1;

THE FOLLOWING SPEND LESS THAN 50%IN THE COMMUNITY:

North Dakota 49.9; South Carolina 49.6; New Jersey 45.9; Nevada 45.5; Idaho 45.5; Iowa 43.1; North Carolina 38.4; Louisiana 34.6; Illinois 34.6; Ohio 34.3; Texas 31.5; Arkansas 26.4; Washington DC 6.5; Mississippi 1.6; Arizona n/a;

National Average 57.6

#3 ONLY PD/AD Community LTC expenditures - National Average 25.1 %

New Mexico 55.2% of PD/AD expenditures in the community; Oregon 55.0%; Alaska 50.9%

THE FOLLOWING SPEND LESS THAN 50% IN THE COMMUNITY:

Washington 49.6%; California 38.9; Idaho 38.2; North Carolina 38.0; Texas 37.6; New York 36.3; Minnesota 35.9; Vermont 32.0; Colorado 29.3; Kansas 28.6; Missouri 27.7; Wisconsin 26.5; Nevada 26.3; Arizona 25.1; West Virginia 24.6; New Jersey 23.8; Maine 23.5; Montana 22.1; Massachusetts 21.9; Connecticut 21.8; Iowa 21.4; Arkansas 20.8; Oklahoma 20.7; Kentucky 20.5; Illinois 20.2; Maryland 19.9; Nebraska 18.6; Wyoming 18.3; South Carolina 18.2; Hawaii 17.8; Ohio 16.7; Virginia 16.3; Georgia 14.8; Michigan 14.7; Washington DC 13.7; Utah 13.7; Delaware 12.6; New Hampshire 12.0; Florida 11.2; Alabama 11.2; Louisiana 10.6; Rhode Island 10.1; South Dakota 9.6; Indiana 9.1; Pennsylvania 6.8; Mississippi 6.4; North Dakota 5.1; Tennessee 0.6;

United States 25.1%

WHAT ADVOCATES SHOULD DO?

1. Isn't it about time that the PD/AD community organized itself at least to equal the MR/DD percent of MA LTC expenditures in the community?

2. Even though many States have made progress in the last five years to more equalize the community versus institutional MA LTC expenditures, we still have a ways to go. When does your State expect to be above 50% in Chart # 1? Has your State even discussed this as a goal? This is a potential strategy for the PD/AG AND MR/DD groups to work together.

3. As your States continue threatening to and actually reducing MA expenditures, PD/AD advocates should compare Chart #3 with In Informational Bulletin # 88, FY 04 - Medicaid Expenditures Institutional (Nursing Homes) vs. Community-based expenditures - State by State (May, 05), see www.stevegoldada.com and click on searchable archives. This will give you the dollar amounts behind the percentages. It will also give you ammunition to organize against proposed MA cutbacks.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. To contact Steve Gold directly, write to stevegoldada@cs.com.