HEALTH CARE AND HUMAN SERVICES POLICY, RESEARCH, AND CONSULTING—WITH REAL-WORLD PERSPECTIVE. Nursing Home Diversion June 2, 3009
HEALTH CARE AND HUMAN SERVICES POLICY, RESEARCH, AND CONSULTING—WITH REAL-WORLD PERSPECTIVE. Nursing Home Diversion June 2, 3009.
Dec 24, 2015
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HEALTH CARE AND HUMAN SERVICES POLICY, RESEARCH, AND CONSULTING—WITH REAL-WORLD PERSPECTIVE.
Nursing Home Diversion
June 2, 3009
2www.lewin.com
Nursing Home Diversion Initiative
A strategy that builds on the Aging Network’s existing
work to develop comprehensive systems of community-
based supports to help people live at home for as long
as possible and avoid or delay spend-down to Medicaid
and unnecessary placement in nursing homes.
► For every non-Medicaid individual diverted from a NH into the community the total savings in federal and state dollars is projected to be over $40,000 per year.
3www.lewin.com
Nursing Facility ResidentsPer 1,000 individuals Age 65+, 2005
31-40 res. per 1,000* 14 – 30 res. per 1,000 41-49 res. per 1,000Connecticut MinnesotaIllinois NebraskaIndiana North DakotaIowa Ohio Kansas Rohde IslandLouisiana South Dakota Massachusetts
Alabama North CarolinaColorado South CarolinaDelaware TexasMaine Vermont Maryland VirginiaMichigan West VirginiaNew Jersey
Alaska OregonArizona Nevada California New MexicoFlorida UtahHawaii WashingtonIdaho
Arkansas New Hampshire District of Columbia New York Georgia Oklahoma Kentucky PennsylvaniaMississippi Tennessee Missouri WisconsinMontana Wyoming
52 – 65 res. per 1,000
HI
AK
MT
ID
WA
CO
WY
NV
CA
NMAZ
MN
KS
TX
IA
WI
IL
KY
TN
INOH
MI
ALMS
AR
LA
GA
FL
SC
WV VA
NC
MDDE
PA NJ
VT
RI
ME
NHOR
UT
SD
ND
MO
OK
NE
NY
CT
DC
MA
National Average = 40 per 1,000 individuals age 65+National Average = 40 per 1,000 individuals age 65+
Source: Mick Cowles (2006) Nursing Home Year Book for residents and Bureau of the Census for population.
4www.lewin.com
© The Lewin Group
Expect more than triple as many NF users in2050 if NF use rates remained at 2004 levels
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Trends in LTC Spending
In 2006, over $150 billion was spent on LTC for seniors.
► 60% were public expenditures (Medicaid, Medicare, OAA and other public funding)
In 2005, 62% of all long-term care resources for all
ages were spent on institutional care
6www.lewin.com
The US LTC System—Challenges
Consumers are not aware of their LTC options Consumer LTC needs often arise during a crisis The LTC System is confusing, disjointed and difficult to
access, navigate and manage LTC System designed around Medicaid/Medicare Inefficiencies in the system often lead to:
► Delays in obtaining appropriate care► Unnecessary expenses, including institutionalization► Unnecessary impoverishment and spend down to Medicaid
7www.lewin.com
Slow the Rate of Growth of the Medicaid Program and Improve the Long-Term Care System► Prioritize non-Medicaid home and community-based service
funding to individuals who are not Medicaid eligible but at high risk of spend-down to Medicaid and institutionalization
► Efficiently and effectively target high-risk individuals through single-entry-point/ADRC systems
► Rapidly authorize and provide consumer-directed services that enable services to be tailored to individual’s unique and changing needs
Nursing Home Diversion Strategy
8www.lewin.com
Nursing Home Diversion Strategy
Home/Community
Nursing Home
Spenddown to Medicaid
Low-Risk of NH Placement & Spenddown to Medicaid
Medium-Risk of NH Placement & Spenddown to Medicaid
High-Risk of NH Placement & Spenddown to Medicaid
Long-Term Care Risk Groups
9www.lewin.com
Effectively Target and serve High-Risk Individuals with Nursing Home Diversion
Initiative via ADRC Single Entry Point to slow rate of growth of Medicaid
Nursing Home Diversion Strategy
Low-Risk of NH Placement & Spenddown to Medicaid
Medium-Risk of NH Placement & Spenddown to Medicaid
High-Risk of NH Placement & Spenddown to Medicaid
Home/Community
Nursing Home
Spenddown to Medicaid
Long-Term Care Risk Groups
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Nursing Home
Low-Risk of NH Placement & Spenddown to Medicaid
Medium-Risk of NH Placement & Spenddown to Medicaid
High-Risk of NH Placement & Spenddown to Medicaid
Nu
rsin
g H
om
e
Div
ers
ion
Nursing Home Diversion Strategy
Home/Community
Spenddown to Medicaid
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System Components of NHD
Single Entry Point/Aging and Disability Resource
Center
Opportunity for Consumer Direction
Financial Management Service Entity (FMS) or Fiscal
Intermediary (FI)
Flexible Services
12www.lewin.com
Process That Led to VDHCBS
Awareness of NHD Initiative and Grant Announcement
Awareness of VHA Desire for Consumer Direction for
Veterans of All Ages
Development of VDHCBS Program and incorporate as
Attachment I of NHD Grant Announcement
Award NHD grants 9/30/08 and identify 10
states/AAA’s that will work with VISNs and VAMC to
roll-out VDHCBS
13www.lewin.com
Medicaid and Nursing Home Diversion Initiative
NHD Grant Award-Only
States
NHD & VDHCBS Award
States
Georgia Arkansas
Illinois Connecticut
Kentucky Florida
Louisiana Massachusetts
Maryland Michigan
Minnesota New Jersey
New Hampshire New York
Ohio Texas
Vermont Virginia
West Virginia Washington
14www.lewin.com
Lisa AlecxihSenior Vice PresidentCenter for Long Term CareThe Lewin Group3130 Fairview Park Drive
Suite 800
Falls Church, VA 22042
(703) 269-5542
www.lewin.com
The Lewin Group | Health care and human services policy research and consulting | www.lewin.com3130 Fairview Park Drive, Suite 800 • Falls Church, VA • 22042 From North America, call toll free: 1-877-227-5042 • [email protected] The Lewin Group is an Ingenix Company. Ingenix, a wholly-owned subsidiary of UnitedHealth Group, was founded in 1996 to develop, acquire and integrate the world's best-in-class health care information technology capabilities. For more information, visit www.ingenix.com. The Lewin Group operates with editorial independence and provides its clients with the very best expert and impartial health care and human services policy research and consulting services. The Lewin Group and logo, Ingenix and the Ingenix logo are registered trademarks of Ingenix. All other brand or product names are trademarks or registered marks of their respective owners. Because we are continuously improving our products and services, Ingenix reserves the right to change specifications without prior notice. Ingenix is an equal opportunity employer. Original © 2008 Ingenix. All Rights Reserved
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