New AARP Report Finds Older Americans Have Limited Access To Home And Community-Based Services Under Medicaid

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Seniors / Aging
Article Date: 12 Jul 2008 - 1:00 PDT


A new report by AARP's Public Policy Institute finds promising signs and mixed results among state government efforts to balance long-term care (LTC) options under Medicaid. Unfortunately, according to the report, only four states spent more than 50 percent of their Medicaid LTC dollars for older people providing home and community based services (HCBS). The remainder of the states continues to spend the majority of their Medicaid LTC dollars for older people on institutional care, such as nursing homes.

The report, A Balancing Act: State Long-Term Care Reform, is the first to examine Medicaid spending on long-term care for older people and adults with physical disabilities, separate from other LTC users such as people with mental retardation/developmental disabilities (MR/DD).

Nationally, 75 percent of Medicaid LTC spending for older people and adults with physical disabilities pays for institutional care in nursing homes. In contrast, states have done a much better job balancing Medicaid LTC for people with MR/DD, spending just 39 percent on institutional care. The majority of funds now support people in home and community-based settings.

"What states have accomplished for people with mental retardation/developmental disabilities is remarkable," said Susan Reinhard, Senior Vice President AARP Public Policy Institute. "It proves that balancing long-term care is achievable and should be used as a model to help states provide home and community based services for older adults."

Medicaid's bias remains a major barrier to leveling the playing field between options for institutional care and HCBS for older adults, according to the report. Medicaid is required to provide nursing home care for older adults who are impoverished and require care, but is not required to provide HCBS.

"This is backwards. People are entitled to costly nursing home care, but not to often more cost- effective services in their homes. Clearly home and community-based services are preferred by older residents," said Reinhard. "Our research shows that older people want to remain in their homes as they age. They want independence, choice and control over every day decisions. However, public funds continue to steer older people into institutions."

Also highlighted in the report are best practices from states that are making progress balancing LTC options. Alaska, Oregon, Washington and New Mexico spent more than 50 percent of their Medicaid LTC budget for older people and adults with physical disabilities in 2006 on HCBS. These states embraced a philosophy of delivering services in a way that allowed older people the greatest independence. The ability of some states to accomplish substantial reforms for older people and adults with physical disabilities - as well as increased HCBS options for MR/DD - demonstrates that obstacles to balancing LTC options can be overcome.

The report examines Medicaid LTC funding because it is the primary payer for LTC in the country. It found that balancing Medicaid LTC options will require a commitment from state officials and cooperation from federal authorities. HCBS can be both cost-effective and responsive to the preferences of older people and adults with disabilities.

"This underscores the need for better government and private sector financing options for long- term care. Americans have few options to plan and pay for their long-term care. Medicare provides only modest funding for a limited number of services and Medicaid's stringent financial eligibility criteria require most people to become impoverished to qualify. It is clear that we must eliminate Medicaid's persistent bias towards costly and undesired institutional care, and we need to advocate for more affordable long-term care financing options. Government, individuals and the private sector all have a role to play," said Reinhard.

The new report includes state rankings and can be found here.

AARP is a nonprofit, nonpartisan membership organization that helps people 50+ have independence, choice and control in ways that are beneficial and affordable to them and society as a whole. AARP does not endorse candidates for public office or make contributions to either political campaigns or candidates. We produce AARP The Magazine, the definitive voice for 50+ Americans and the world's largest-circulation magazine with over 33 million readers; AARP Bulletin, the go-to news source for AARP's 39 million members and Americans 50+; AARP Segunda Juventud, the only bilingual U.S. publication dedicated exclusively to the 50+ Hispanic community; and our website, AARP.org. AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors, and sponsors. We have staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands.

www.aarp.org

• Additional
• References
• Citations