Steve Gold: Medicaid Reductions and People with Disabilities

As the economy continues to dramatically impact on State budgets, Medicaid expenditures will come under attack. Here are some suggestions advocates might wish to consider. I think it is very important to keep emphasizing the ADA and the importance of keeping people with disabilities and the elderly in the community.

1. Focus on your state’s Medicaid nursing facility expenditures.

Nationally, from FY 2002 through FY 2007, the national % increase in Medicaid nursing facilities’ expenditures was only 1.3%. However, many states had significantly larger increases.

The following 21 states had more than a 20% increase in nursing home expenditures during these six years: Alabama, Alaska(45%), California, Colorado, Connecticut, Delaware, Florida, Hawaii, Kentucky, Maine, Maryland, Mississippi(55%), Nevada(45%), New Hampshire, North Carolina, Oregon, South Carolina, Tennessee, Utah(70%), West Virginia (35%), and Wyoming.

Organize to force your state to cap its nursing facility expenditures.
As long as your state continues to increase its Medicaid nursing home expenditures, nursing facilities will have an incentive to admit people who could otherwise live in the community. Therefore, no more Medicaid increases to unnecessarily institutionalize people with disabilities.

2. Save Medicaid funds by transferring nursing homes expenditures.

Get your state to tell nursing home residents that if a person moved to the community each of them will receive at least 90% of the amount of Medicaid funds your State spends on them in nursing facilities. In FY 2007, nationally states spent nearly $47 billion of Medicaid expenditures on nursing homes, compared to only $6.3 billion on all Aged/Disabled Waivers in the community.

For people who want to live in the community, your state could save 10% of the nursing home expenditures and, at the same time, do what people want
– permit them to reside in their own homes and apartments with services paid with the 90% of the nursing home costs.

3. Save Medicaid funds in hospital reimbursements.

In FY 2007, nationally states spent $43 billion on in-patient hospitalizations. Many of those people were hospitalized for some time because there was not a community-based support system where they could receive the same supportive services they were receiving in the hospitals.

I do not have good data that reflects how many days people were unnecessarily hospitalized primarily because there was not system to provide services in the community. However, I do know that nearly 60% of nursing home admissions are directly from acute care hospitals. Many of those people would not have gone to a nursing facility if there were a real choice and if someone explained to talked to them about community-based services.

4. Close the front door of nursing homes.

I am still dumbfounded why 11% of nursing home admissions are for persons who were in their own homes and apartments and had not received any home health services before they went straight into a nursing facility. (This 11% is separate from the 60% who were admitted from an acute care
hospital.) Clearly, states have not “closed the front door,” but still permit people to be admitted directly into nursing homes without the state Medicaid officialsb or advocates for elderly and disabled b asking these folks what services they might need and want to stay in their own homes and apartments.

5. Other Suggestions - Send In Your Ideas!

Please email to stevegoldada@cs.com, subject: “save Medicaid funds”.

Steve Gold, The Disability Odyssey continues

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To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.