1. Ashley Steffen Spalding University Healthcare Policy and Regulation Final Presentation November 18 th, 2015 Long-term Care in Medicaid

2. Introduction Regulation: Long-term Care in Medicaid Description: What is long-term care? History: How did long-term care begin? General regulation impact: How does long-term care affect the greater population? Specific regulation impact: Who benefits the most from long- term healthcare? Personal insights: My family background and experience with long-term care

3. Description of Medicaid Regulation Medicaid is a state and federal program that helps people with low income pay for medical bills. Largely funded federally, but run by each individual state. Medicaid covers long-term care such as home healthcare visits and nursing home stays. Long-term care custodial costs can be funded through Medicaid and not Medicare. Morone, J.A., & Ehlke, D.C. (2013). Health politics and policy. Stamford, Connecticut: Cengage Learning. U.S. Department of Health and Human Services. (2015). Find your path forward: State medicaid programs. Retrieved from http://longtermcare.gov/medicare-medicaid-more/medicaid/.

4. Program Rules Eligibility for MedicaidState Qualifications for Medicaid Eligibility varies from state to state Have income levels below state requirements Elderly felt degraded which led to the passing of the Medicare Catastrophic Coverage Act Some seniors are not eligible for Medicaid at the time of nursing home entry. States cover certain groups of individuals States can cover certain services, but also have the option to expand to different services too Once determined if a person’s income level meets the eligibility requirements, states can then assess if individuals are eligible for long- term care services Use a specific number of personal care needs to assess long-term care eligibility Morone, J.A., & Ehlke, D.C. (2013). Health politics and policy. Stamford, Connecticut: Cengage Learning. U.S. Department of Health and Human Services. (2015). Find your path forward: State medicaid programs. Retrieved from http://longtermcare.gov/medicare-medicaid-more/medicaid/.

5. History of Medicaid Timeline  1970s- Medicaid emerged as public purchaser of nursing home care  1980s- Medicaid became America’s effective long-term care program  1981- home- and community-based waiver  1988- Passed Medicare Catastrophic Coverage Act (MCCA)  1989-Repeal of MCCA  1990s- Expenditures for nursing home care began to rise  1997- Minnesota implemented a model combining Medicaid and Medicare-finance older people from well to frail. MSHO developed. Many states followed suite.  1999- Olmstead v. L. C.-Increase in Medicaid eligibility for individuals with disabilities, women and children  2010- Health care reform passes ACA and Medicaid is made more significant Morone, J.A., & Ehlke, D.C. (2013). Health politics and policy. Stamford, Connecticut: Cengage Learning. Saucier, P., Burwell, B., & Gerst, K. (2005). The past, present and future of managed long-term care. U.S. Department of Health and Human Services. Retrieved from http://aspe.hhs.gov/basic-report/past-present-and-future-managed-long- term-care.

6. General Long-term Care Impact Ability of elderly to afford long-term care Financial depletion of assets No Assets, 50% of Assets over 4 Years and 50% of Assets in 1 Year Poor Elderly not eligible for Medicaid cannot afford healthcare Poor Elderly who are eligible for Medicaid might not be able to receive all the services they need Without long-term care in Medicaid, financial responsibility of nursing home care would fall on family members Long-term care varies from state to state Alecxih, L., & Kennell, D. (1994). The economic impact of long-term care on individuals. U.S. Department of Health and Human Services. Retrieved from http://aspe.hhs.gov/basic-report/economic-impact-long-term-care-individuals#secV. Salam, R., (2011). Is medicaid a welfare program? The Agenda. Retrieved from http://www.nationalreview.com/agenda/265573/medicaid-welfare- program-josh-barro

7. Specific Long-term Care Impact State to State Member benefits include assistance with healthcare costs Study conducted to identify long-term care impacts among nursing homes in Arizona and Minnesota who were the most impacted The study involved conducting reviews and researching literature trends in Arizona and Minnesota Interview providers to best identify implications American Health Care Association. (2006). The implications of medicaid managed care for long-term care on nursing facility providers. Ejay, LLC. Retrieved from http://www.ahcancal.org/research_data/funding/Documents/Medicaid_Managed_Care_Report.pdf. http://www.ahcancal.org/research_data/funding/Documents/Medicaid_Managed_Care_Report.pdf

8. Long-term Care State Differences Arizona (ALTCS) Arizona Long-Term Care System (ALTCS) Enrollment is mandatory Offers complete array of medical services Single delivery package coordinated by program contractors Eligibility is based on PAS instrument Program contractors paid on per member per month basis American Health Care Association. (2006). The implications of medicaid managed care for long-term care on nursing facility providers. Ejay, LLC. Retrieved from http://www.ahcancal.org/research_data/funding/Documents/Medicaid_Managed_Care_Report.pdf. http://www.ahcancal.org/research_data/funding/Documents/Medicaid_Managed_Care_Report.pdf

9. Long-term Care State Differences Minnesota Senior Health Options (MSHO) Enrollment is voluntary Combines Medicaid and Medicare financing and services for people over 65 Offers medically necessary Medicaid state plans community- based waiver options Pays for the first 180 days of nursing facility for enrollees who enter after enrolling Dual eligibility Payments are made based on the level of need Minnesota (MSHO) American Health Care Association. (2006). The implications of medicaid managed care for long-term care on nursing facility providers. Ejay, LLC. Retrieved from http://www.ahcancal.org/research_data/funding/Documents/Medicaid_Managed_Care_Report.pdf. http://www.ahcancal.org/research_data/funding/Documents/Medicaid_Managed_Care_Report.pdf

10. Minnesota Elderly people in Minnesota are required to receive healthcare services from prepaid health plans (i.e. Minnesota Senior Plus Care and MSHO) MSHO includes all prescription drugs, Medicare and Medicaid in one plan January 2006-80% of seniors enrolled in managed care plans also were in MSHO. Individuals with incomes not exceeding maintenance need are eligible for program services American Health Care Association. (2006). The implications of medicaid managed care for long-term care on nursing facility providers. Ejay, LLC. Retrieved from http://www.ahcancal.org/research_data/funding/Documents/Medicaid_Managed_Care_Report.pdf. http://www.ahcancal.org/research_data/funding/Documents/Medicaid_Managed_Care_Report.pdf Punelli, D. (2012). Long-term care services for the elderly. Minnesota: Research Department Minnesota House of Representatives. Retrieved from http://www.house.leg.state.mn.us/hrd/pubs/ltcelderly.pdf.

11. Long-term Care Evaluation Eligibility Gap Costs can be Scary State Programs Health care programs will constantly change

12. Personal Insights into Minnesota Medicaid Long-term Care Grandmother fell needing to stay in nursing home Paid for 180 days or until she was well Coverage only provided until sufficient care was decided Moved to an assisted living Using Minnesota Medicaid to pay for care

13. Conclusion Regulation and Description: Brief overview of long-term care in Medicaid History: Synopsis of long-term care background General regulation impact: Benefits and areas of opportunities in long-term care Specific regulation impact: Minnesota Medicaid and long-term care Personal insight: Unwell Minnesota Grandmother receiving long-term care

14. References Alecxih, L., & Kennell, D. (1994). The economic impact of long-term care on individuals. U.S. Department of Health and Human Services. Retrieved from http://aspe.hhs.gov/basic- report/economic-impact-long-term-care-individuals#secV.http://aspe.hhs.gov/basic- report/economic-impact-long-term-care-individuals#secV American Health Care Association. (2006). The implications of medicaid managed care for long- term care on nursing facility providers. Ejay, LLC. Retrieved from http://www.ahcancal.org/research_data/funding/Documents/Medicaid_Managed_Care_Report. pdf. http://www.ahcancal.org/research_data/funding/Documents/Medicaid_Managed_Care_Report. pdf Morone, J.A., & Ehlke, D.C. (2013). Health politics and policy. Stamford, Connecticut: Cengage Learning. Punelli, D. (2012). Long-term care services for the elderly. Minnesota: Research Department Minnesota House of Representatives. Retrieved from http://www.house.leg.state.mn.us/hrd/pubs/ltcelderly.pdf. Salam, R., (2011). Is medicaid a welfare program? The Agenda. Retrieved from http://www.nationalreview.com/agenda/265573/medicaid-welfare-program-josh-barro. http://www.nationalreview.com/agenda/265573/medicaid-welfare-program-josh-barro Saucier, P., Burwell, B., & Gerst, K. (2005).The past, present and future of managed long-term care. U.S. Department of Health and Human Services. Retrieved from http://aspe.hhs.gov/basic- report/past-present-and-future-managed-long-term-care.http://aspe.hhs.gov/basic- report/past-present-and-future-managed-long-term-care U.S. Department of Health and Human Services. (2015). Find your path forward: State medicaid programs. Retrieved from http://longtermcare.gov/medicare-medicaid-more/medicaid/.http://longtermcare.gov/medicare-medicaid-more/medicaid/