DOH/Long Term Care Perspective

  • Document is also available in Portable Document (PDF)

15th Annual Elder Law Forum
Mark Kissinger, Deputy Commissioner
Office of Long Term Care
May 6, 2010

  • Complicated
  • Comprehensive
  • Programs overlap
  • Reliant on informal care network
  • NYS spends more than any other state per capita on Medicaid ($2,360) and twice the national average ($1,077).
  • Medicaid spending will still reach $51.5 billion, a 1.8% increase over 2009, if all Executive Budget proposals are enacted.
28% of Medicaid Spending ($12.3B) is on Long Term Care Servicest

Data Source: NYS DOH/OHIP Datamart (CY 2008)

($ in Millions) $ Change in Spending 2003 to 2008 % Change in Spending 2003 to 2008 Change in # of Recipients 2003 to 2008 %Change in # of Recipients 2003 to 2008
Nursing Homes $715.10 12.00% -7,780 -5.60%
CHHAs $414.10 54.50% -11,130 -12.00%
Personal Care $503.30 27.60% -7,023 -8.30%
CDPAP $147.10 99.40% 3,433 24.20%
MLTC $634.00 142.70% 17,674 143.80%
  • Recognizing the importance of informal caregivers;
  • Promoting consumer choice and independence;
  • Ensuring that individuals receive care in the most appropriate setting to meet their needs while allowing for the greatest amount of autonomy possible;
  • Promoting home and community-based options;
  • Rightsizing the "system" of long term care to reduce costs and ensure quality care;
  • Improving the quality of life of individuals receiving long term care in residential facilities and community settings; and
  • Improving surveillance efforts.
  • Uniform Assessment Tool (UAT)
  • Rightsizing efforts (HEAL NY, ALPs, ALRs)
  • Expanding home and community based options (NHTD, TBI, MFP…)
  • Promoting quality of life in community-based and residential settings
  • Improving safety and surveillance (Home Care Registry, QIS…)
  • Nursing home and home care budget actions
  • Personal care utilization management
  • Persons receiving PCSP will be eligible for up to an average of 12 hours/day over the course of their authorization period.
  • Persons requiring services in excess of the 12 hours/day average are eligible to move into certain waiver programs.
  • Affected persons can move to programs such as: Managed Long Term Care (MLTC), CDPAP, the Nursing Home Transition and Diversion Waiver (NHTD), and the Long Term Home Health Care Program (LTHHCP).
  • State will pick up expenditures that fall outside the aggregate cap limitation for the NHTD waiver.
  • This proposal will take effect for assessments and reassessments occurring on or after July 1, 2010.
  • NYS spends significantly more, per recipient, than any other state on personal care services, spending more than $2.3 billion/year on PCSP services to approximately 82,000 individuals.
  • All other states with a PCSP limit program expenditures by capping allowable hours, establishing more restrictive eligibility criteria, or providing the services only within a cost-neutral waiver program.
  • A limit on the number of hours/month of PCSP services will result in individuals with significant care needs utilizing alternative service delivery models that provide care management.
  • County Long Term Care Financing Demonstration Program supports up to 5 counties to shift county nursing homes to alternative settings.
  • Long Term Care Financing Demonstration Program allows Medicaid eligibility for up to 5,000 persons under certain conditions.
  • Nursing Home Rightsizing Demonstration Program expands to additional 2,500 beds.

Establish up to 5 demonstrations in counties that operate nursing homes to transform capacity into investments in other long term care services.

  • Recognizes ongoing difficulties of county nursing homes.
  • Allows innovation in addressing hard to serve populations.
  • Creates incentive to increase access and support for community based settings.

Provide Medicaid Extended Coverage (MEC) to individuals choosing to finance part of their care.

  • Allows the state to work with individuals to make private contributions for their own long term care costs.
  • Allows the testing of another avenue to finance long term care.
  • Limits the demonstration to 5,000 persons.
  • Requires approval by the federal government.

Increase the cap on the NH rightsizing demonstration from 2,500 beds to 5,000 beds.

  • Rightsizing demonstration allows nursing homes to convert beds to long term home health care slots, adult day care slots, and/or assisted living program slots.
  • Complements Assisted Living expansion.
  • Undertake reimbursement study of Assisted Living Program (ALP) based on resident data generated from a uniform assessment tool (UAT).
  • Extend the Transitional Care Unit (TCU) demonstration by five years and increase the number of sites by five.
  • Replace EnABLE and QUIP with a new ACF quality initiative.
  • Seek federal approval for establishment of a Federal - State Medicare Shared Savings Partnership.