Monday, April 8, 2002
*** New Content for the Donor-Only Zone (DOZ):
two items for the Reader and two for the Data Base:
The LTC Reader #13--Insider Information on Medicare's Alzheimer's Coverage
The LTC Reader #14--Bitter Irony: Medicaid Eligibility Easier for Rich than Poor
The Data Base #13--Eight Percent of All Nursing Homes Still
The Data Base #14--Nursing Homes Approach Medicare "Cliff"
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*** LTC Graduate Seminars are scheduled for Baltimore on April 22, Pittsburgh on May 13 and Philadelphia on May 14. Register now: firstname.lastname@example.org. We're considering the week of June 17 to 21 for LTC Graduate Seminars in Dallas and New Orleans. Firm dates and locations soon. For all the latest details, jump to http://www.centerltc.com/ltc_grad_seminar.htm. Once you've expressed interest in attending an LTC Graduate Seminar by notifying email@example.com, we'll keep you posted on dates and locations near you. ***
In an LTC Bullet published August 3, 2000 and titled
"Will Olmstead Help or Hurt Long-Term Care?," we asked a provocative
question. We wondered whether the
Supreme Court's Olmstead decision, requiring states to serve people with
disabilities in community settings rather than in institutions (such as nursing
homes), would increase or decrease the availability of home and community based
services in the long run.
We concluded "To the extent the Olmstead decision is
successful in compelling state Medicaid programs to pay for HCBS 'not only to
persons already in institutional settings but to those being assessed for
possible institutionalization,' Medicaid long-term care eligibility, utilization
and expenditures will explode. Medicaid
estate planning will expand. Long-term
care insurance will contract. The
tension between demand for publicly financed HCBS and the taxpayers' willingness
to pay for such services will increase. Skyrocketing Medicaid budgets will force lawmakers to
restrict services to cut costs. Access
and quality will suffer even more than before.
The poor will bear the brunt of deficient care while the well-to-do will
shoulder even higher out-of-pocket expenditures. And, in the end, even fewer people will have access to
high-quality, home and community-based long-term care than now."
You can read our original Bullet at http://www.centerltc.com/bullets/archives2000/olmstead.htm,
but here's an update on current conditions from an article titled "Massive
New Spending Needed to Comply with Olmstead Ruling," published in the
January 14, 2002 issue of "Aging News Alert."
"Financially strapped states need massive sources of
new revenues to comply with the Supreme court's Olmstead ruling to house the
elderly and disabled, if possible, in the community.
"The federal government recently released $64 million
in new grants to 37 states and one territory to help with planning.
But that is only the beginning. Compliance
will require a major investment in the number of residential housing units
suitable for the elderly and disabled."
"[W]hile the states are being called on to move the
elderly into the community, many states, which managed to avoid cuts in Medicaid
last year, are already considering reducing payments to nursing homes this year.
"In a yet to be released report, Fox-Grage [a senior
policy analyst at the national Conference of State Legislatures] finds only
three states have started implementing measures to move the elderly into the
community more than two years after the Supreme Court decision."
"Only four states--Miss., Mo., Ohio and Texas--have
developed plans with specific strategies and goals, designated the role of
various state agencies, include time lines and budgets and meet CMS
"At the current rate, she says, it will be a 'long,
long, long time' before states meet the Olmstead goals."
LTC Comment: In the meantime, the points we made in our original Olmstead Bullet remain true. Building up the false hope that Medicaid will pay for quality care in the community only anesthetizes the public to the real risk of long-term care, reduces their sense of urgency about the risk, impedes the market for privately financed home and community-based services, discourages the purchase of private long-term care insurance and, therefore, reduces Medicaid's capacity to provide for the needs of the poor. This is just another example of how good intentions often pave the way to unintended negative consequences.