ohio’s unified long-term care budget building a cost-effective, consumer friendly long-term...

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


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.


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.

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.


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”.


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



Global Budgeting:Global Budgeting:The Colorado ExperienceThe Colorado Experience

By Dann Milne, Ph.D.

Consultant

Ph: 303-399-6736

[email protected]

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

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.


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.


Decision Roadmap

• Who will be served by the long-term services and supports budget?

• What does “long-term services and supports” include?


Questions for theSubcommittees


“Front Door” Subcommittee

• What will be the design of the “front door” to long-term services and supports?


Care Management Subcommittee

• What is the role of care management?

• Who benefits from care management?

• How will we interface with Medicare Special Needs Plans?


Quality Subcommittee

• How will we incorporate the CMS “quality framework” into all aspects of long-term services and supports, including nursing facilities?


“Unmet Needs” Subcommittee

• What unmet needs currently exist and what additional long-term services and supports should Ohio offer?


Consumer Direction Subcommittee

• How will we incorporate the key principles of consumer direction into the system?


IT Systems Subcommittee

• How will existing and planned IT systems be modified to accommodate a unified budget?


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

ohio’s unified long-term care budget building a cost-effective, consumer friendly long-term...

Documents

system slide

nursing homes slide

states flexibility slide

disparate services

transparent budget

person mfp

funding community

budget authority