Information Bulletin # 297 from Steve Gold, January 07, 2010
In the previous Information Bulletin (#296), we reviewed how well your State has done at ending discrimination against the elderly and people with physical disabilities in its Medicaid Long Term Care expenditures and services.
In this Information Bulletin, we focus on how your State has done at ending discrimination against people with developmental disabilities, again focusing on the allocation of Medicaid Long Term Care expenditures between institutional versus community-based services.
Allocation of Medicaid Long Term Care expenditures demonstrates a State's commitment to provide the persons with developmental disabilities a choice between unnecessary institutionalization and living in the community.
The FY 2008 Medicaid data for DD is now available, 10 years after the Supreme Court ruled to end unnecessary institutionalization.
Nationally, in FY 2008 for persons with developmental disabilities, 35.5% of Medicaid's entire LTC expenditures were allocated to institutional services and 64.5% on community-based services. In dollars, state centers and ICF-MRs (the DD institutions) received $11.9 billion compared to $21.7 billion for community-based services.
Let's compare this with FY 2006, when nationally 39.3% of Medicaid's entire LTC expenditures for persons with developmental disabilities were allocated to institutional services and 60.7% went to community-based services. In dollars in FY 2006, institutions received $12.5 billion compared to only $19.3 billion for community-based services.
Going back to FY 2004, nationally 42.4% of Medicaid's entire LTC expenditures for persons with developmental disabilities were allocated to institutional services and 57.6% on community-based services. In dollars, institutions received $11.7 billion compared to only $15.9 billion for community-based services.
Therefore, between FY 2004 and FY 2008, there has been a seven percent change in allocation between institutional versus community services.
There has been a steady and progressive trend to reduce institutional expenditures and to increase community expenditures. Whether this reduction has occurred quickly enough is another issue.
Let's break FY 2008 expenditures down:
In FY 2008, there were only 7 states that spent less than 50% of their Medicaid LTC in the community (which means that all the other states allocated more of their LTC expenditures to the community): IL, LA, AR, TX, NJ, DC and MS. In FY 2006, there were 12 States in this dishonorable category.
There were 14 states that spent more than 80% of their Medicaid LTC in the community. These States deserve special honorable mention: OR (100% in the community!!!), NH, RI, MI, CO, HI, NM, MD, AL, MT, MN, WY, ME, and KA.
Here are States that increased their community expenditures more than 5% between FY 2006 and FY 2008, which means they decreased their institutional expenditures by 5%: DC, LA, TX, NC, KY, CT, TN, GA, MO, NV, and CO.
Special recognition goes to DC: it went in FY 2006 from 18.2% in the community to FY 2008 with 48.9% to the community.
Three States unfortunately decreased their community expenditures by more than 5% between FY 2006 and FY 2008: NJ, SC, and MA.
Here are States that have ranked consistently as the worst for DD expenditures in the community: MS, LA, AR, TX, NJ, IO, NC, ID, ND, OH.
Here's the state-by-state FY 2008 Institutional Expenditures by % for Developmental Disabilities:
STATE
Alabama, 12.2% LTC Institutional Expenditures
Alaska, X 37.7%
Arizona, ** ---
Arkansas, 56.3%
California, X 28.2%
Colorado, 6.9%
Connecticut, 32.9%
Delaware, 25.9%
D. C., 51.1%
Florida, X 32.5%
Georgia, 24.6%
Hawaii, 7.3%
Idaho, 47.5%
Illinois, 57.9%
Indiana, 39.5%
Iowa, 49.7%
Kansas, 18.4%
Kentucky, 35.2%
Louisiana, 57.1%
Maine, 17.7%
Maryland, 9.5%
Massachus, 27.0%
Michigan, 3.9%
Minnesota, 16.0%
Mississippi, X 100%
Missouri, 24.2%
Montana, 14.5%
Nebraska, 30.8%
Nevada, 22.8%
New Hampshire, 1.9%
New Jersey, 54.6%
New Mexico, 7.7%
New York, X 40.6%
North Carolina, 49.3%
North Dakota, 45.8%
Ohio, 45.1%
Oklahoma, 31.7%
Oregon, 0%
Pennsylvania, 30.5%
Rhode Island, 3.8%
South Carolina, 35.9%
South Dakota, 20.3%
Tennessee, 29.2%
Texas, 55.6%
Utah, 31.8%
Vermont, X ---
Virginia, 38.8%
Washington, 25.1%
West Virginia, 21.5%
Wisconsin, ** 21.5%
Wyoming, 16.3%
National, 35.5%
** These States do not include expenditures for managed care programs that provide long-term care.
X These States had reporting errors or omissions.
Special thanks to Medstat/Thompson for collecting and organizing the data.
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 or call 215-627-7100.
his Information Bulletin focuses on how your State allocates its Medicaid Long Term Care expenditures between its institutional versus community-based services.
these funds demonstrates its commitment and respect to the ADA and the 1999 Olmstead decision which held that unnecessary institutionalization is discrimination.
The FY 2008 Medicaid data was recently released. It's collected by CMS and published by Medstat/Thompson. In previous years, I have tried to combine in one Information Bulletin data for Aged/Disabled and Developmental Disabilities. This year instead I will send our separate Information Bulletins.
This one will focus only on "Aged/Disabled".
How a state allocates its Mediciad Long Term Care expenditures demonstrates its commitment to provide the elderly and persons with disabilities a choice between unnecessary institutionalization and living in the community. In the immediate years after the 1999 Supreme Court decision in Olmstead, we all made a number of excuses for why States could not quickly comply with this decision. Well, the FY 2008 Medicaid data is for the 10th year after the Supreme Court ruled to end unnecessary institutionalization.
Nationally, in FY 2008 for the aged and persons with physical disabilities, 68.4% of Medicaid's entire LTC expenditures were allocated to institutional services and 31.6% on community-based services. In dollars, nursing homes received $49 billion compared to only $22.6 billion for community-based services.
Let's compare this with FY 2006, when 71.4% of Medicaid's entire LTC aged/disabled expenditures were allocated to institutional services and 28.6% on community-based services. In dollars, nursing homes received $47.7 billion compared to only $19.2 billion for community-based services. Not much change between FY 2006 and FY 2008!
Let's break it down:
In FY 2008, there were only 4 states that spent more in the community (more than 50% of their Medicaid LTC for Aged/Disabled) than in institutions:
NM, WA, OR, and CA. These were the same states in FY 2006.
Here are States that increased their community expenditures by more than 5% between FY 2006 and FY 2008, which means they decreased their institutional expenditures by 5%: DC, CO, VG, LA, GA, and VT.
Nationally, 31.6% of MA's LTC for Aged/Disabled are Community Expenditures
- waivers, personal care option and home health. The following States in FY
2008 allocated less than 21.6% of their MA LTC for Aged/Disabled community
services: CT, NY, MI, HI, KY,NH, MD,AL, PA, RI, DE, SD, IN, ND, FL, MS, TN, UT.
The following States allocated more than 31.6% of their MA LTC for Aged/Disabled in the community: NM, WA, OR, CA, NC, TX, ID, DC, NY, CO, KA, NV, MN, VT, AK.
Here are States that have ranked consistently as the worst - meaning, they allocate very little in the community and overwhelmingly most of their Aged/Disabled expenditures to keep people institutitonalized - between FY 2004 and FY 2008: ND, MS, IN, SD, DE, RI, AL.
Here's the state-by-state FY 2008 Institutional Expenditures by % for
Aged/Disabled:
M STATE
Alabama, 84.3% LTC Institutional expenditures
Alaska, X 36.6%
Arizona, ** 78.4%
Arkansas, 73.1%
California, ** 47.9%
Colorado, 61.4%
Connecticut, 78.4%
Delaware, 87.1%
D. C., 58.7%
Florida, **X 82.9%
Georgia, 76.7%
Hawaii, 81.2%
Idaho, 58.7%
Illinois, 74.7%
Indiana, 88.1%
Iowa, 72.0%
Kansas, 62.7%
Kentucky, 81.5%
Louisiana, 70.2%
Maine, 75.3%
Maryland, 84.1%
Massachusetts, ** 75.8%
Michigan, 80.3%
Minnesota, ** 47.0%
Mississippi, X 98.1%
Missouri, 69.4%
Montana, 68.5%
Nebraska, 76.4%
Nevada, 64.4%
New Hampshire, 83.8%
New Jersey, 79.2%
New Mexico, ** 36.1%
New York, ** 61.0%
North Carolina, 54.9%
North Dakota, 90.6%
Ohio, 78.0%
Oklahoma, 69.4%
Oregon, 46.4%
Pennsylvania, 86.4%
Rhode Island, 86.8%
South Carolina, 75.7%
South Dakota, 87.7%
Tennessee, ** 96.1%
Texas, ** 56.2%
Utah, X 101.6%
Vermont, ** 67.6%
Virginia, 69.4%
Washington, 40.5%
West Virginia, 76.4%
Wisconsin, ** 69.0%
Wyoming, 77.6%
National, 68.4%
** These States do not include expenditures for managed care programs
that provide long-term care
X These States had reporting errors or omissions. .
Special thanks to Medstat/Thompson for collecting and organizing the data.
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 or call 215-627-7100.