Friday, February 9, 2007

SteveGoldADA: MFP Rebalancing Benchmarks & 50-50 or Bust..

Hopefully speaking for themselves.. Once again, Steve's is one of the lists that, if you only wish to receive a few advocacy-based emails, this would be a nice addition..

Money Follows the Person "Rebalancing Benchmarks" - Information Bulletin #193.

Two weeks ago, CMS sent out "Money Follows the Person Rebalancing Demonstration Request for Additional Information" letters to 21 states. These are the 21 States that were not awarded "first round" MFP grants of more than $800 million, but are eligible for a "second round" grant. These 21 states have only until February 20 to respond to the CMS questions and concerns.

Whether your State will receive a MFP grant in the "second round" ($700 million remains) depends on how your State responds to CMS' questions and concerns. Based on the CMS letters we have seen, CMS appears serious about requiring "Rebalancing Benchmarks," i.e., how will your State decrease the ratio of institutional to community expenditures? What will your State, in order to receive the enhanced federal match, do to demonstrate its seriousness on the home and community based side of the scale?

CMS suggests one "measurable benchmark" which we think is critical and will demonstrate if your State is really serious about "rebalancing" its Medicaid long term care expenditures. Namely, CMS suggests "A percentage increase in Home and Community Based services versus institutional long-term care expenditures under Medicaid for each year of the demonstration program." CMS is right on the mark!

For the past several springs we have provided by State a comparison of the Medicaid expenditures for institutional versus community-based services. Nationally in FY 2005, for persons who receive "A/D" services, i.e., older Americans and disabled persons, nearly 73% of the funds went to the institutions and 27% went to community-based services.

A true rebalancing benchmark would reduce those ratios so that each year, as one example, the percentages for institutional care would be reduced by 5% and the community-based services expenditures would be increased by 5%. By the end of the five year grant, we would see a true "rebalancing." The same principle applies for MR/DD services.

Congress understood that the primary purpose of MFP was to "rebalance" Medicaid's expenditures from the institution to the community.

Why would a State not want to rebalance and to establish such benchmarks in return for an increase in federal money? How could CMS ever approve an State's proposal that did not establish such benchmarks?

Disability Advocates:

  1. Do you know if your State was one of the 21 that received a request for additional information?
  2. If it was, has your State Medicaid agency shown you the CMS letter?
  3. Are you meeting with your State to discuss these benchmarks and the rebalancing?

50 - 50 or Bust! Money Follows the Person - Information Bulletin # 193A.

A number of folks responded to the "Money Follows the Person "Rebalancing Benchmarks'" Information Bulletin that was issued a few days ago. I suggested that "A true rebalancing benchmark would reduce those ratios [of Medicaid expenditures for the Aged/Disabled] so that each year, as one example, the percentages for institutional care would be reduced by 5% and the community-based services expenditures would be increased by 5%. By the end of the five year grant, we would see a true 'rebalancing.' The same principle applies for MR/DD services."

People were quite upset with only a 5 % rebalancing per year. I was reminded that at least five states (Oregon, Alaska, New Mexico, Washington, and California) were already at the 50% -50% institutional versus community Medicaid expenditures for "Aged/Disabled" long-term care services.

So we were challenged. Why not 50% -50% in "Aged/Disabled" MA expenditures by 2010 for every state?

Outrageous? The Human Services Transition Team for Massachusetts new Governor has proposed a 50/50 balance by 2010. In FY 2005 (the last year for which we have data), Massachusetts spent 77% on institutional Aged/Disabled and 23% for community-based services. Massachusetts' 2010 goal reflects a meaningful rebalancing.

Here are the States, starting with the most Unbalanced (again FY 2005). We provide the % going to institutional for Aged/Disabled. (This data is from the CMS 64, Office of State Agency Financial Management, as collected and published by Medstat on July 7, 2006.)

These States have a VERY LONG WAY TO GO! It's not too late.

Institutional for Aged/Disabled; % of total long term care expenditures:

  • Tennessee 98.9%, the most unbalanced.
  • Mississippi 96.7%
  • North Dakota 95.0%
  • Indiana 92.3%
  • Pennsylvania 90.5%
  • Utah 90.3%
  • South Dakota 89.7%
  • New Hamp. 89.5%
  • Rhode Is. 89.1%
  • Alabama 88.4%
  • Delaware 87.9%
  • Florida 87.9%
  • Georgia 87.6%
  • Louisiana 84.7%
  • Michigan 84.7%
  • Hawaii 82.7%
  • Maryland 82.6%
  • Kentucky 82.2%
  • S. Carolina 81.9%
  • Wash., DC 81.9%
  • Ohio 81.6%
  • Nebraska 80.6%
  • Wyoming 80.0%
  • Illinois 79.1%
  • Virginia 78.9%
  • New Jersey 78.8%
  • Iowa 78.7%
  • Conn. 78.5%
  • Mass 77.0%
  • Maine 76.9%
  • W. Virginia 76.7%
  • Oklahoma 76.2%
  • Colorado 75.0%
  • Arkansas 74.0%
  • Nevada 72.5%
  • Wisconsin 72.0%
  • Missouri 71.7%
  • Montana 71.3%

What are the Aged/Disabled advocates doing in these States to achieve a 50/50 balance?

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