Click to edit Master title style Click to edit Master subtitle style Aging and Disability Resource Centers: A Keystone to LTC Rebalancing Info. About & Access to Services Critical to Success March 28, 2008 presented by : Lisa Alecxih

2 Session Overview  Rebalancing Progress and Strategies  Aging and Disability Resource Centers  New Jersey’s Journey  Kentucky’s Consumer Choice

3 Medicaid LTC Devoted to HCBS for Aged and Disabled Grew Significantly Since 2000

4 18.2% HCBS 20-32%* HCBS 33-54% HCBS 10-19% Alabama Connecticut Delaware DC Florida Georgia Indiana Kentucky Maryland Mississippi New Hampshire North Dakota Pennsylvania South Dakota Tennessee Utah Alaska California Idaho Minnesota New Mexico North Carolina Oregon Texas WashingtonWisconsin Uneven Progress Among States: % HCBS of Medicaid LTC Among Aged/Disabled, 2005 HCBS <10% *National Average = 23.6% HI AK MT ID WA CO WY NV CA NMAZ MN KS TX IA WI IL KY TN IN OH MI ALMS AR LA GA FL WV VA PA NJ VT RI ME NH OR UT SD ND MO OK NE NY CT DC MA 7.3% Arkansas Kansas Maine Massachusetts Missouri Montana Nevada New York Oklahoma Vermont Virginia Colorado Hawaii Illinois Iowa Louisiana Michigan Nebraska New Jersey Ohio Rhode Island South Carolina West Virginia Wyoming Source: 2006 Thomson Healthcare Medicaid LTC Data, Lewin Analysis. SC DE MD NC NJ KY

5 Aged/Disabled Behind Developmentally Disabled: % HCBS for Individuals with ID-DD Quadrupled

6 System Changes to Promote LTC Balance: Financing Strategies  Global Budgets  Money Follows the Person  Nursing Home Bed Buy Backs  Expansion of Home and Community- based Alternatives  Capitated Managed Long Term Care

7 System Changes to Promote LTC Balance: System Strategies  Knowledge for Informed Choices ―Easily accessible and understandable ―Options counseling  Interventions in Critical Pathways to Institutionalization ―Outreach to hospital discharge planners, physicians… ―Pre-admission screening for institutions  Accelerated Eligibility Determination ―Fast track ―Presumptive eligibility  Consumer Direction  Transitions out of Nursing Facilities

Click to edit Master title style Click to edit Master subtitle style ADRCs Basics/Accomplishments

9 visible trustedall ages full rangelong term single point To have Aging and Disability Resource Centers in every community serving as highly visible and trusted places where people of all incomes and ages can turn for information on the full range of long term support options and a single point of entry for access to public long term support programs and benefits. CMS and AOA Vision

10 How close are we to the vision?

11 Statewide Coverage  List of Statewide ADRCs growing ―8 with physical statewide coverage  Alaska, Kentucky, Louisiana, New Hampshire, Rhode Island, West Virginia, Guam, and Northern Mariana Islands ―5 with legislation or administrative commitment to go statewide  Wisconsin, Florida, Michigan, Illinois and Indiana  30% of US population lives in ADRC service area

12 Target Populations Served Target Population Percent of Pilot Sites Number of States Adults Aged 60 and Over 100%43 People with Physical Disabilities 94%38 People with MR/DD/ID 59%24 People with Mental Illness 53%16 All Disabilities 27%12

13 ADRC Legislation and Funding  ADRC Legislation: Florida and Michigan  State Appropriations: 18 states contribute money to ADRC pilot sites budget ―Kentucky, Maryland, Georgia, Indiana, and New Hampshire received significant state appropriations recently to continue and expand ADRC initiative.  NY and CT have ADRC like initiatives  Medicaid Federal Financial Participation for Administrative Functions  Private Grants

14 One Stop Access

15 ADRC is More a Process than an Entity Changing Program Identity Moving from experts working in isolation to co-location, formal coordination, routine communication, cross-training Changing Program Focus Moving from focus on eligibility, programs and services to a proactive consumer-oriented approach with intensive outreach to individuals of all income levels and comprehensive options counseling How is this achieved? FORMAL PARTNERSHIPS

16 Partnerships Play an Important Role in ADRCs State Level n=39 Pilot-Site Level n=97 Total No. of Partnerships Avg. No. of Partners Data from Spring 2007

17 Medicaid’s Interest  Institutional diversions  Outreach and possibly support coordination for transitions  Infrastructure to address Olmstead  Potential to slow the rate of Medicaid long term services and supports growth  Improved appropriateness of Medicaid eligibility applications and reduced administrative burden for verifications

18 What is Different About ADRCs?  Strong consumer orientation ―Make it easier for consumers to get what they need  Not only information and referral ―Follow through and tracking of consumers  Streamlines access to services ―Conducts or facilitates eligibility for public programs ―Assists private pay in finding appropriate services

19 What is Different about ADRCs? (cont.)  Focus on appropriate setting for services & supports ―Intervention in critical pathways ―Options counseling  Combines aging and disability ―Similar basic needs, but acknowledges difference  Requires multiple partnerships on all levels ―Only practical way to do one stop shop concept  Effective use of technology ―Web-based resource databases ―Information exchange protocols and software across partners

20 Conclusions  ADRCs have expanded and continue to expand rapidly nationally  States have adopted different organizational models to expand their programs in ways that are unique to them  Success requires: ―Consistent effort (staffing, training, funding) ―Careful planning ―Committed leadership at the state and local level ―Highly-engaged partners (including consumers)  Information sharing and technical assistance are important facilitators of successful ADRC expansion