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State governments that are trying to balance long-term care (LTC) options under Medicaid have a long way to go, according to a new report by AARP's Public Policy Institute. But progress is evident.
According to the report, "A Balancing Act: State Long-Term Care Reform," just four states spent more than 50 percent of their Medicaid LTC dollars for older people providing home- and community-based services. Medicaid is the primary payer of LTC in the country.
In New York State, for example, 74 percent of Medicaid LTC dollars for older people and adults with physical disabilities who have limited financial resources are spent on nursing homes. In Pennsylvania, that number is 90 percent.
Across the country, 75 percent of Medicaid LTC spending for older people and adults with physical disabilities pays for institutional care in nursing homes.
In contrast, states have done a much better job balancing Medicaid LTC for people with developmental disabilities, spending just 39 percent on institutional care. The majority of funds now support people in home- and community-based settings.
"We recognize the success state Medicaid programs are having providing home- and community-based services to people with developmental disabilities," said Lois Aronstein, AARP New York State director. "It proves that balancing long-term care is doable and should be used as a model to help states provide home and community-based services for older adults."
The report includes best practices from states that are making progress balancing LTC options. For instance, Alaska, Oregon, Washington, and New Mexico spent more than 50 percent of their Medicaid LTC budget for older people and adults with physical disabilities in 2006 on home- and community-based services.
AARP actively works to increase opportunities for the aging population to age in place with home- and community-based services. This year, AARP championed the inclusion of funding for enhanced home- and community-based services in the New York State budget. The final budget included funding for seven regional caregiver centers, including respite services, start-up grants to enable communities to develop support services to enable older persons to age in place, and enriched social adult day care services.
As part of its Commonwealth Long-Term Living Project, Pennsylvania set a goal of 50 percent home-based care to 50 percent institutional care for all LTC populations by fiscal year 2011-12. However, the recently passed 2008-09 state budget included no new spending to reduce existing home- and community-based services waiting lists for the state's lottery-funded OPTIONS program.
"This underscores the need for better government and private sector financing options for long-term care," said Dick Chevrefils, state director in Pennsylvania for AARP. "Americans have few options to plan and pay for their long-term care. Balancing Medicaid LTC options will require a commitment from our state officials and cooperation from federal authorities."
The new report, which includes state rankings, is available at the AARP Web site.
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