SB12-128, Efficiencies in Medicaid Long-Term Care

SB 12-128

ACHIEVING EFFICIENCIES IN THE MEDICAID LONG-TERM CARE PROGRAM THROUGH GREATER UTILIZATION OF ALTERNATIVE CARE FACILITIES

Sponsors: Senator Roberts, Representative Summers

Staff Name:  Kasey Baker

What the Bill Does:
SB12-128 would establish a 3-year pilot program for alternative care facilities in the Medicaid program. The program would utilize alternative care facility placements for Medicaid clients receiving long-term care (LTC) services. The state department would reimburse alternative care facilities at a rate of $3000 per month, per client, reduced by the client portion of the cost. Alternative care facilities would be allowed up to 1000 clients. The program would take effect on or before September 1, 2012 and end July 1, 2016.

Colorado Context:

• The number of Coloradans needing long-term care is increasing.
• The state general fund expenditures for long-term care already represent a significant portion of the state’s medical assistance budget.
• Many people who need long-term care are unaware that they may be able to receive services in a home-like environment, rather than a nursing home, and at a lower cost to the Medicaid program.
• Many alternative care facilities have vacancies but cannot accept Medicaid clients because the reimbursement rate for these facilities under the Medicaid program is insufficient.

National Context:
The number of people who need LTC services is expected to increase rapidly during the next several decades. Clients overwhelmingly indicate they prefer home- and community-based care, and with evidence that such care is less costly in most cases, state policymakers have been “rebalancing” or redefining their LTC systems. Today, every state has federal waiver programs that allow them to provide a wide range of HCBS services. (The populations eligible for these benefits and the types of services offered vary significantly by state, and waiver programs have capped enrollments.)

Vermont, Wisconsin, and Texas have implemented programs to manage their long-term care costs while providing alternatives to institutionalization: 

• Vermont implemented its “Choices for Care” program in 2005. This approach gives those with disabilities choice and equal access to either nursing homes or HCBS. Financed by a global budget, the program combines Medicaid funding for HCBS waiver programs and nursing home care. The Vermont program is operating under a Medicaid 1115 Research and Demonstration waiver.
• Wisconsin’s “Family Care” program, a managed-care pilot program, launched in five counties. In February 2006, Governor Jim Doyle announced plans to expand the program statewide. Two additional counties began participating in 2007. It operates under a combination of 1915(b) and 1915(c) Medicaid waivers. Family Care combines funds and services from a variety of existing programs. Services are tailored to each enrollee’s needs and preferences, and participants can remain in their homes in most cases and self-direct their services.
• Texas’s “Money Follows the Person” program allows nursing home residents to move out of an institution to community settings if they request it and if community care is appropriate for them. The funds that would have been used for their nursing home care are channeled instead to community care. More than 10,000 individuals had chosen to leave nursing homes under the program by spring 2006. Encouraged by federal grants and by a new federal demonstration program, the Texas example now is being adopted by other states.    

source: http://www.ncsl.org/issues-research/health/long-term-care-faq.aspx

Bill Provisions:

• SB 12-128 would establish a 3-year pilot program for alternative care facilities in the Medicaid program.
• The program would utilize alternative care facility placements for Medicaid clients receiving long-term care (LTC) services.
• To be eligible for the pilot program, a client must:
  • Be Medicaid-eligible,

• Residing in a nursing facility,
• AND be reasonably expected to need long-term care for the foreseeable future.

• In order for the client to be referred to an alternative care facility, a single entry point agency must assess that the client will achieve the same or better health outcomes and client satisfaction in the alternative care facility as in his or her current nursing facility placement.
• The state department would reimburse alternative care facilities at a rate of $3000 per month, per client, reduced by the client portion of the cost. Alternative care facilities would be allowed up to 1000 clients.
• The program would take effect on or before September 1, 2012 and end July 1, 2016.

Fiscal Impact:  There is no fiscal note yet available for SB12-128.