State of Vermont. Patrick Flood. Commissioner Vermont Department of Disabilities, Aging and Independent Living
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1 State of Vermont Patrick Flood Commissioner Vermont Department of Disabilities, Aging and Independent Living
2 Shifting the Balance Act 160 Vermont Department of Disabilities, Aging, and Independent Living
3 The reductions required in subsection (a) of this section shall be redirected in fiscal year 1997 to fund home and community-based services. For fiscal year 1998 and thereafter, the reductions required in subsection (a) of this section shall be redirected in that fiscal year to fund both home and community-based services and any programs designed to reduce the number of nursing home beds. Any general funds that are redirected but not spent during any fiscal year shall be transferred to the long-term care special administration fund which is hereby created.
4 Public Expenditures for Long Term Care FY % Community-Based Services 88% Nursing Homes FY % Community-Based Services 68% Nursing Homes
5 Nursing Home Medicaid Expenditures Actual vs "Without Act 160" * $160,000,000 $151,667,788 $140,000,000 $120,000,000 Actual Spending Without Act 160. (FY83-FY96 avg rate of increase = 8.3%) $100,000,000 $102,485,177 $80,000,000 $60,000,000 Act 160 $40,000,000 $20,000,000 $ Fiscal Year
6 Decline in Vermont's Nursing Home Residents vs Growth in H&CB* Medicaid Waiver Slots 1,200 1,000 MW Slots NH Residents ,200 4,000 MW Slots ,800 3,600 3,400 NH Residents , End of Fiscal Year 3,000
7 Comparison of Public Expenditures for Nursing Homes and Home & Community-Based Programs FY FY 2005 $120,000,000 $100,000,000 Nursing Homes Community Programs $94,577,138 $90,552,604 $101,336,043 $102,485,177 $80,000,000 $79,269,834 $79,325,760 $73,911,253 $74,113,368 $74,691,808 $73,246,780 $60,000,000 $40,000,000 $33,163,986 $39,118,493 $43,272,065 $48,196,215 $20,000,000 $9,673,419 $10,566,289 $13,675,694 $16,631,901 $22,203,774 $25,394,117 $ Fiscal Year 88/12* 87/13 84/16 82/18 78/22 76/24 73/27 71/29 70/30 68/32 %
8 Average Medicaid Daily Rate* for VT Nursing Home Beds $ $ $ $ $ $ $147.87^ Medicaid Daily Rate $ $ $80.00 $60.00 $40.00 $67.06 $55.35 $51.37 $60.91 $47.66 $53.64 $50.00 $45.38 $81.49 $72.46 $89.98 $88.22 $97.20 $92.36 $ $ $ $ $ $20.00 $ est State Fiscal Year
9 Medicaid Choices for Care: Nursing Home Residents and Home & Community-Based Participants--May 2006 Changes (Yellow) Needed to Achieve 60/40 Balance 100% 15 80% % 18 40% 20% % Addison Bennington Caledonia Chittenden Franklin Grand Isle Lamoille Orange Orleans Rutland Washington Windham Windsor Average number of Medicaid Nursing Home Residents/day Nursing Home Resident Reductions or HCBS Participant Increases HCBS (Home & Community Based Services) "Active" Participants
10 25% Percent of Vermont Elders Residing in Nursing Homes--By Age % % % Use Rate 15% 10% 13% % % Age
11 Saving a Nursing Home Problem: 120 beds empty beds Losing $500,000 per year Needed some, not all of the beds
12 What We Did: Right size to 80 beds Increase rate to cover fixed costs Used some savings for additional slots Home is fine, 98% full and making a small profit
13 Vermont s 1115 Long-Term Care Waiver Proposal Choices for Care
14 Services Consumers Prefer
15 Goals for this Proposal Provide choice and equal access Serve more people Manage the costs of long term care Improve the system Create a balanced system Prevention
16 Keys to Success Expand, but manage entitlement to both nursing home care and home-based care Give consumers choice and equal access Serve more people as funds become available
17 EXISTING SYSTEM High Nursing Home Home & Community-Based Waiver Enhanced Residential Care Waiver Eligibility threshold Acuity Not Nursing Home Level of Care Low
18 High 1115 ELIGIBILITY Highest Need Proposed Level for Entitlement Group Acuity High Need Group Current Level of Care Low Moderate Need Group
19 EXISTING SYSTEM Nursing Home Entitlement 2200 Waiver Services 1200 Eligible but not Entitled
20 1115 PROPOSAL Highest Need (Entitlement) High Need Group Moderate Need Group
21 Important Elements Increase Public Information Increase Quality Assurance Community Ombudsman Cash and Counseling
22 Important Elements Preventive services for Moderate Needs Group Expand Resource Limit to $10,000 for homebased care with cost sharing Promote Long-Term Care Insurance
23 Demonstration Elements Predictors of Institutional Placement? Cost Effectiveness? Prevention and delay of institutional care? Improved customer satisfaction
24 Demonstration Elements Improved service array and system capacity? Impact on nursing home acuity and census? Impact of educational programs?
25 Budget Neutrality 7.28% Annual Growth Inflation Case Load
26 4500 Choices for Care: Total Number of Enrolled Participants October June Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Nursing Facility Home and Community Based (Highest and High Needs) Home and Community Based (Moderate Needs) Enhanced Residential Care
27 Choices for Care Applications Received by Month, by Service Program October, May, 2006 Moderate Needs Nursing Facility HCBS ERC Number of Applications Received Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06
28 $4,000 Choices for Care: Average Monthly Costs of Approved Plans of Care October, June, 2006 $3,500 $3,655 $3,629 $3,614 $3,629 $3,598 $3,595 $3,553 $3,536 $3,527 $3,000 $2,500 $2,000 $1,500 $1,794 $1,780 $1,773 $1,772 $1,766 $1,746 $1,748 $1,748 $1,766 $1,000 $500 $- ERC HCBS (highest and high needs) 10/1/ /1/ /1/2005 1/1/2006 2/1/2006 3/1/2006 4/1/2006 5/1/2006 6/1/2006
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