KVH Issue Brief Outlines New Options to Provide Care to Elderly and Disabled Kentuckians at Home

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Feb 16th, 2012

New KVH Issue Brief Outlines New Options to Provide Care to Elderly and Disabled Kentuckians in Their Homes

Thousands of elderly and disabled Kentuckians could receive long-term care services at home if Kentucky would take advantage of new options available under the federal health reform law. Although seniors vastly prefer receiving care at home instead of in a facility, Kentucky relies more than most other states on nursing homes to provide long-term care. The Affordable Care Act gives states an opportunity to make less costly in-home and community-based services more widely available under the Medicaid program.

These findings are included in New Options for Independent Living: How the new health reform law can expand in-home and community-based care as an alternative to nursing homes, an issue brief released today by Kentucky Voices for Health (KVH). (Download a full copy of the issue brief at http://kyvoicesforhealth.com/research.html.)  The brief is intended to help policymakers and Kentuckians in general understand the new federal policy options that could expand the availability of in-home and community-based care.

“As a coalition of Kentuckians focused on building a healthier Kentucky, we want to ensure that our citizens have access to the best quality care in the least restrictive environment that is comfortable to them,” said Laurel True, KVH Board of Directors. “Taking advantage of federal programs like the Affordable Care Act will enable our seniors and people who need assistance with activities of daily living to maintain their quality of life in the communities of their choice.”

According to the brief, more than 29,000 Kentuckians reside in some type of long-term care facility.  More than 65 percent of that care is paid for by the Kentucky Medicaid program at an annual cost of $986 million. In fact, Kentucky spends about twice as much on institutional care as it does on home and community-based alternatives, making it a national leader in this category. Only three other states spend a higher percentage of their Medicaid long-term care expenditures on nursing facilities.

Also of concern is the fact that Kentuckians do not take full advantage of the nursing home alternatives that are currently available. For example, only two-thirds of the available slots under the Home and Community Based Waiver Program – the primary alternative to nursing homes covered by Medicaid – were filled in fiscal 2011. That left slots for 5,805 people unused. Medicaid’s income guidelines provide a key reason for this under-use: participants in the waiver program may keep only $718 per month in income while patients a long-term care facility may keep more than twice that amount.

“KVH is working together with its partners to increase the efficiency and effectiveness of the delivery of healthcare services to Kentuckians,” stated Jodi Mitchell, KVH Executive Director.  “In-home and community-based care is an option that will help to curb healthcare costs and strains on the current Medicaid budget.”

In addition to costing less, the expanded use of home- and community-based services has strong public support. A 2007 survey of older Kentuckians found that nine in 10 wanted to stay in their homes as long as possible, and 85 percent supported increased funding for services to help people remain in their homes as they age.

With the demand for long-term care services expected to grow dramatically as Kentucky’s population ages, the issue brief recommends a number of steps to reduce the emphasis on facility-based care in the Medicaid program and increase the use of in-home and community-based services. These include:

• Take advantage of the new options in the Affordable Care Act to expand in-home and community based services:

• The Community First Choice Option to pay for personal attendant services in a home or community setting
• The State Balancing Incentives Payment Program to increase federal funding for the Home and Community Based Waiver program
• Extending spousal impoverishment protections now available to Medicaid recipients in nursing facilities to those in home- and community-based programs to encourage participation and take advantage of unused slots
• Extending the Money Follows the Person Demonstration project to return more people to their home communities from long-term care facilities

• Improve outreach for home and community-based care to encourage participation (including outreach to hospital discharge planners to ensure they understand and have up-to-date information on the available options to institutional care)
• Strengthen case management to ensure that Medicaid recipients are receiving the appropriate care at home or in the community where possible.

“By taking these actions to expand community-based services, Kentucky can avoid the higher cost of facility-based care while giving people what they really want: the opportunity to grow old while receiving quality care in their own homes,” the brief concludes.

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