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 Unified Long-term Care System Workgroup Submits Recommendations
Plan drives a long-term care system that controls Medicaid spending, is based on choice
Ohio's Unified Long-term Care System (ULTCS) Workgroup submitted 26 recommendations to Governor Ted Strickland, Governor-elect John Kasich and members of the General Assembly in December. The workgroup's report suggests ways the state can create a flexible budget for Ohio's long-term services and supports, such as PASSPORT and other Medicaid waiver programs, and provides cost-effective solutions to budgeting for the future long-term care service needs of Ohioans.
"Medicaid spending now consumes 40 percent of the state budget," said Barbara E. Riley, director of the Department of Aging and chair of the workgroup. "The elderly and adults with disabilities make up 20 percent of those on Medicaid, yet account for 68 percent of costs, including 70 percent of Ohio's nursing facility care. The workgroup's recommendations will position Ohio to better address the needs of the growing number of baby boomers and adults with disabilities while reining in Medicaid spending."
The workgroup's 26 recommendations, to be implemented in the FY 2012-13 biennium, fall into five categories: balance and funding, eligibility, integration and care management, service array and workforce.
Balance and funding: Because it costs about one-third as much as similar care in an institutional setting, serving more consumers in home- and community-based services (HCBS) settings can save taxpayer dollars. The balance and funding recommendations include changing consumer distribution between institutional and HCBS, from 60 percent institutional and 40 percent HCBS in 2007 for adults with physical or cognitive disabilities, age 60 and older, to a 50/50 distribution. For adults age 59 and younger, the workgroup recommends a 40/60 distribution (40% institutional and 60% HCBS); in 2007, this was 50/50. Once these goals are reached, the workgroup plans to recommend new distributions that will put Ohio on track to reaching the national average.
Eligibility: Ohio should apply the expanded Home First concepts of imminent risk of nursing facility placement to the Ohio Home Care waiver, as well as apply the eligibility criteria and logic that currently are used in the PASSPORT waiver to Assisted Living waiver applications, allowing quicker delivery of needed services. Other recommendations include expanding the role of the area agencies on aging as lead agencies in Aging and Disability Resource Networks (ADRNs); helping individuals with mental illness to relocate from nursing facilities to community settings and establishing appropriate reimbursement rates for long-term care providers to ensure sustained quality of care for all consumers.
Integration and care management: Provider, case manager and consumer education about the requirements for Medicare, Medicaid and other programs will ensure that program benefits are used to the fullest extent and will aid in program integration and care management. Agency partnerships and long-term care consultants in medical facilities can help adults who need long-term care supports and services. ADRNs can help integrate medical and long-term care services by expanding access to information, assistance and long-term care consultations. In addition, shared consumers need to be identified to support service coordination.
Service array: The workgroup developed recommendations about services to support HCBS such as discharge planning, transportation, access to housing, service coordination, consumer direction and telehealth.
Workforce: Also recommended was the creation of a Direct Service Workforce Consortium to develop a strategy to link resources, programs, data and direct service workers with potential long-term care service and support provider employers.
Ohio's Unified Long-term Care System Workgroup was created by the General Assembly and Governor Strickland in H.B. 119, and has been working for four years to re-engineer the state's long-term care system into one that controls Medicaid spending and is based on choice, not funding streams. The workgroup consists of consumer advocates, providers and state policymakers. In 2008, the workgroup unanimously approved more than 120 recommendations, many of which have been implemented.
Since the formation of the ULTCS Workgroup, Ohio has made great strides in establishing a unified long-term care system that is based on consumer choice. The report containing the 26 recommendations also summarizes these accomplishments and serves as Ohio's compliance with the U.S. Supreme Court Olmstead ruling.
The full text of the report is available on the Ohio Department of Aging website
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