k a i s e r c o m m i s s i o n o n medicaid and the uninsured figure 0 long-term care: exploring...
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K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 1
Long-Term Care: Exploring the Possibilities
Diane Rowland, Sc.D.Executive Vice President,
Henry J. Kaiser Family Foundationand
Executive Director, Kaiser Commission on Medicaid and the Uninsured
for
Alliance for Health ReformWashington, DC
March 9, 2009
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 2
Who Pays for Long-Term Care?
Total = $124.9 billionNote: Total LTC expenditures includes only spending on nursing home and home health services. Some community-based services financed primarily through Medicaid home and community-based waivers and delivered in other settings are not represented here. SOURCE: KCMU estimates based on CMS National Health Accounts data, 2008.
Out-of-Pocket
22%
Other Private
3%
Other Public3%
Private Insurance
9%
Medicare23%
Medicaid40%
Total = $177.6 billion
Nursing Home Care ExpendituresTotal Long-Term Care Expenditures
Out-of-Pocket
26%
Other Public2%
Other Private
4%Private Insurance
7%
Medicare17%
Medicaid43%
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 3
Medicaid Long-Term Care Users Account for 7 Percent of Enrollees But Over Half of Spending
Individuals Who UseNo Long-Term CareServices
Individuals Who UseCommunity-BasedServices
Individuals Who UseInstitutional Services
33%
48%
93%
4%3%
Total = 51.4 million Total = $228.2 billion
Enrollees Expenditures
19%
Note: Data include spending on acute and long-term care services by users. Source: KCMU and Urban Institute estimates based on MSIS 2002.
52%
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 4
Dual Eligibles’ Share of Medicaid Enrollment and Spending, FFY 2005
18%46%
Enrollment Spending
Dual (Medicare & Medicaid) Non-Dual
49.8 million $ 287.3 billion
Source: Urban Institute estimates based on data from MSIS and CMS Form 64, prepared for the Kaiser Commission on Medicaid and the Uninsured, 2008.
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 5
10%
23%
21%
23%
9%
15%
39%
51%
55%
2%
57%
Long-Term CareResident
NonelderlyDisabled
Fair/Poor Health
Less than HighSchool Education
Cognitive/MentalImpairment
Income $10,000 orLess
Other Medicare Beneficiaries Dual Eligible Beneficiaries
Comparison of Dual Eligible and Other Medicare Beneficiaries, 2006
SOURCE: KFF analysis of the Medicare Current Beneficiary Survey 2006 Access to Care File.
61%
Total = 7.5 Million Dual Eligible Medicare Beneficiaries
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 6
Growth in Medicaid Long-Term Care Expenditures, 1991-2006
1990 1995 2000 2002 2004 2006
$32
$54
$75
87% 80%
70%
In Billions:
13%
20%
30%32%
68%
$92
Institutional care
Home & community-based care
63%
37%
$100$109
41%
59%
Note: Home and community-based care includes home health, personal care services and home and community-based service waivers.SOURCE: KCMU and Urban Institute analysis of HCFA/CMS-64 data.
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 7
Reform Options at the State Level
• Home and community-based services (HCBS) waivers
• Demonstration grants with enhanced matching funds
• HCBS State Plan Options– Allows states to offer HCBS services as a state plan option rather
than through a 1915(c) waiver
• Self-direction of personal assistance services
– Medicaid beneficiary has greater control over hiring, scheduling and paying personal care attendants
• Long-term care Partnership Programs
– Allow persons who purchase qualified LTC insurance policies to shelter some or all of their assets when applying for Medicaid after exhausting their policy benefits
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 8
Number of States with Medicaid Long-Term Care Expansions
5
9
15
33
1
10
8
38
EnhancedInstitutional
Services
Added AdditionalServices HCBS
Waiver
Implemented orExpanded PACE
New or ExpandedHCBS Waiver
FY 2008 Adopted for FY 2009
Note: State actions to expand HCBS waivers include those receiving Money Follows the Person demonstration grants.SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, September 2008.
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 9
Increased Flexibility with DRA Long-Term Care Options
13
1 1
8
4
1
43
17
LTC PartnershipPrograms
Self-Direction ofPersonal Services
HCBS State PlanOption
2007 2008 Adopted for 2009
SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, September 2008.
Number of States
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 10
Key Challenges in Long-Term Care
• Medicare coverage for long-term care is limited
– Provides limited nursing home care (100 days) for those recently discharged from a hospital
• Better coordination of dual eligibles is needed
• Private sector options are still limited and often costly
• The demand for long-term care will continue to grow and families will continue to play a critical role in provision of care and financing home care and nursing home care