Overview of Virginia Medicaid and Long Term Care Services

1
Overview of Virginia Medicaid and Long Term Care
Services
Terry A. Smith, Director Division of Long Term
Care and Quality Assurance
Department of Medical Assistance Services
September 7, 2006
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Presentation Outline
Overview of Medicaid Trends and
Expenditures Medicaid Long Term Care Services
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The Faces of Our Customers

• The years teach much
• which the days never knew.
• Ralph Waldo Emerson

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Medicaid Enrollment Trends
690,898
Notes Average monthly enrollment in the
Virginia Medicaid Program
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Medical ServicesExpenditure Trends
State Fiscal Year
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Medicaid Enrollment Trendsby Eligibility Category
Notes Annual unduplicated enrollment in the
Virginia Medicaid program
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Medicaid Expenditure Trendsby Eligibility
Category
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Medicaid Enrollment ExpendituresFY 2005
Aged
10
26
Aged
20
Blind Disabled
Adults
13
Blind Disabled
45
57
Children
Adults
9
21
Children
Recipients
Expenditures
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Medicaid Expenditure TrendsAverage Annual Cost
per Enrollee
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Presentation Outline
Overview of Medicaid Trends and
Expenditures Medicaid Long Term Care Services
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• The best is yet to come and wont that be fine?
• 
  Frank Sinatra

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Medicaid Long-Term Care Services

• Institutional Services
• Nursing Facility 1st in the nation to have a
  pre-admission screening criteria and assessment
  developed and implemented
• Assisted Living Facilities
• Intermediate Care Facilities for the Mentally
  Retarded (ICF/MR)
• Durable Medical Equipment
• Specialized Care in Nursing Facilities
• Home Health
• Hospice
• Community Based Services
• Home and Community Based Care Waivers (Seven
  Waivers) 2nd in the nation to provide waivers
  (1982)
• Program of All-Inclusive Care For the Elderly
  (PACE)

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Medicaid Waivers in Virginia
Source CMS 372 reports for FY 2005
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Two New Waivers Have Been Implemented

• Day Support Waiver for People with Mental
  Retardation
• Individuals who meet the criteria for ICF/MR
  placement and are diagnosed as having mental
  retardation and are on the waiting list for the
  MR waiver
• 300 slots
• Alzheimers Waiver
• Individuals who have a diagnosis of Alzheimers
  or related dementia and meet nursing facility
  criteria
• Are at least 55 years in age (regulations under
  revision)
• Are receiving an Auxiliary Grant
• Reside in an assisted living facility
• 200 slots

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Eligibility for Long-Term Care Services

• To be eligible for Medicaid-funded long-term care
  services individuals must
• Financially qualify for Medicaid and
• Meet specified long-term care criteria according
  to a standardized long-term care assessment
  instrument
• Uniform Assessment Instrument (UAI) for nursing
  facility level of care (includes all
  home-and-community based)
• Level of Functioning (LOF) Survey for ICF/MR
  level of care

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Medicaid Plays an Essential Role as the Primary
Funding Source for Long Term Care

• In 2004, Medicaid accounted for 47 of national
  long-term care spendingthe single largest source
  of financing for long term care.
• Medicare and private health insurance provide
  limited coverage
• Medicaid paid for 67 of institutional care.
• Eighty percent of the elderly with long term care
  needs receive help solely from family and friends
  who are not paid for these efforts
• In FY 2005, more than 25,000 Virginians received
  care in a nursing facility and more than 19,000
  received long term care services in the
  community.

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Percentage of Expenditures by Type of LTC in
Virginia(total about 1.2 billion)
Waivers
(30)
(51)
Nursing Facilities
(19)
ICF/MR
The Statistical Record of the Virginia Medicaid
Program, SFY 2004
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The Future of Long Term Care Several
CommunitiesAre Interested in the PACE Model

• Virginia has had one Pre-PACE site for several
  years. Sentara, which serves the Tidewater area,
  is moving to make this a full PACE site by late
  2006/early 2007.
• Other communities interested in providing a PACE
  program
• Lynchburg
• Charlottesville
• Richmond (newest area of interest)
• Northern Virginia
• Hampton
• Tazewell
• Big Stone Gap
• To this end, Governor Kaine submitted a budget
  amendment to provide 1.5 million to at least six
  sites in start up funds.

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The Future of Long Term Care Integration of
Acute and Long Term Care Services

• ADVANTAGES FOR OUR CUSTOMERS
• For our seniorsit delays institutionalization
  and maintains them in their home and community
  settings. For persons with disabilitiesit
  maintains and/or delays the progression of the
  disability continuum.
• A care coordinator serves as a single point of
  contact for customers and their caregivers for
  all covered health and long-term care services.
• There is flexibility in utilizing the appropriate
  mix of services home health, personal
  assistance, adult day care---not found in a
  fragmented fee for service program. The lowest
  cost service at the optimal level can be
  provided.
• Support services are provided in a decisive
  manner to avoid hospital admission, ensure
  disease state management compliance, and create
  opportunities for successful discharge planning.

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The Future of Long Term Care Integration of
Acute and Long Term Care Services

• ADVANTAGES FOR THE COMMONWEALTH
• Streamline administration
• Provider performance levels are monitored
• Fraud and abuse mechanisms are in place
• Provide preventive services to the elderly and
  persons with disabilities to delay or avoid the
  need for more costly and more restrictive long
  term care services
• Coordinate Medicare and Medicaid services/funding
• Stable and predictable state expenditures

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The Future of Long-Term Care

• Envision a world that values age, a nation that
  embraces agea Commonwealth that honors age.