The national move to home and community-based care away from nursing homes has been widely supported by senior citizen, consumer and disability rights communities. Surveys show older Americans prefer receiving health care services at home instead of in institutional settings.
In recent years nearly a million people with disabilities or conditions severe enough to qualify for nursing home admission have been enrolled in Medicaid-managed long-term care programs, which operate like HMOs. In theory, the care for those very ill beneficiaries should improve with better coordination and lower costs. In Medicaid-managed long-term care, states pay private health plans monthly fixed rates to provide eligible beneficiaries’ health care and services like transportation, home health nurses and personal aides for dressing, cooking and other activities of daily living. Plans only make money if they provide care for less than the monthly fixed fees. But most of the 26 states involved are new to providing managed long-term supports and services for this population.
It’s been a rocky transition for many beneficiaries and their families, who have seen cuts in services to parents and loved ones. Many have scrambled to find new doctors, hospitals and personal attendants. And while states like Texas and Wisconsin have seen costs drop, others such as Florida have seen hikes in health care spending.
New York allowed its health plan contractors to assess eligibility for the long-term care program and the number of enrollees and program costs rose significantly. The Visiting Nurse Services New York paid the U.S. attorney in New York City $35 million in 2014 to settle fraud allegations for enrolling ineligible beneficiaries.
And Connecticut and Oklahoma abandoned their managed long-term supports and services programs.
This population uses many more health care and support services — services previously delivered mostly in nursing homes. States, which struggle with rising Medicaid costs, have learned that providing those services at home costs far less than nursing home stays. But politically savvy nursing home lobbies successfully fought those efforts for decades. In most states, however, the tide is changing.
– Chicago Tribune