I had the opportunity to attend the National Home and Community Based Services Conference held in Arlington, Virginia, in mid-September. It was hosted by the National Association of States United for Aging and Disabilities (NASUAD), which represents the nation’s 56 state and territorial agencies on aging and disabilities. The talk of the day focused on health care reform and the role of Medicaid managed care in long-term care. Attendees also heard from Assistant Secretary for Aging Kathy Greenlee, a featured speaker, on the recent formation of the Administration for Community Living (ACL).Aging & Disabilities Administrations Join Forces
The Administration for Community Living was created approximately five months ago through the merging of the Administration on Aging, the Office on Disability, and the Administration on Developmental Disabilities into a single entity. Its goal is to help seniors and people with disabilities live in their homes and fully participate in their communities. My colleagues and I at United HomeCare share this goal.
Greenlee, who leads the Administration for Community Living at the U.S. Department of Health and Human Services, addressed ACL’s commitment to building the capacity of the national aging and disability networks to better serve older persons, caregivers, and individuals with disabilities. She shared some of the strategies ACL is pursuing to achieve its key objectives, which are to:
• Reduce the fragmentation within Federal programs
• Enhance access to quality health care and long-term services and supports
• Promote consistency in community living policy throughout the Federal government
• Complement the community infrastructure, as supported by both Medicaid and other Federal programs
Focus on Reform
The Administration for Community Living will have an important role to play in the implementation of portions of the Affordable Care Act (ACA) that impact long-term care delivery for children with developmental disabilities, adults with physical disabilities, and seniors. There are four major opportunities:
• Money Follows the Person (MFP) – assists states in reducing the use of institutionally-based care for persons needing long-term services and supports; the ACA extended the demonstration program through fiscal year 2016
• Balancing Incentive Program (BIP) – allows states that currently spend less than 50 percent of long-term care expenditures on home and community-based services (HCBS) to receive additional federal matching funds for HCBS
• Community First Choice Option – provides community-based attendant services and supports to beneficiaries eligible for nursing homes and other institutional settings with incomes up to 150 percent federal poverty level
• 1915(i) State Plan Option – expands HCBS by targeting particular groups of people and making the HCBS benefit accessible to more beneficiaries
Most of these programs will not have a role here in Florida. Only the Section 1915(i) state plan option has been implemented in Florida, and it is currently limited to serving delinquent youth with serious emotional disturbances. Meanwhile, a $35.7 million MFP-awarded grant was declined by the state of Florida due to its federal court challenge of the Affordable Care Act.
The Community First Choice (CFC) program could ultimately prove too costly to implement for many states including Florida. It has a prohibition on waiting lists for waiver services, and, due to the ACA-mandated expansion of Medicaid eligibility in 2014, there is potential for a significant increase in the demand among eligible beneficiaries. As of September 2012, only California has been approved for funding through the CFC program, providing an enhanced federal Medicaid match of six percent to the state.
Florida’s Future
According to the Center for Health Care Strategies, Medicaid pays for nearly 50 percent of the nation’s total spending on long-term supports and services. As a result, there is significant pressure for states to better manage the long-term care needs of Medicaid beneficiaries. Florida’s chosen path to long-term care reform moves to a managed care model. As we embark on this transition, protecting continuity and quality of care will be essential for achieving long-term success.
In a proactive effort to keep providers abreast of the changing long-term care landscape in Florida, United HomeCare conducted provider town hall meetings over the summer in Miami-Dade County, with additional meetings scheduled to take place in Broward County in the coming weeks. For more information on future provider town hall meetings, please contact at vrosas@unitedhomecare.com.
