1. HEALTH CARE AND HUMAN SERVICES POLICY, RESEARCH, AND CONSULTING - WITH REAL-WORLD PERSPECTIVE. Interactive Workshop: Reaching and Serving Private Pay 2010 AoA, CMS, and VA Grantee National Meeting February 22-24, 2010 Alexandria, Virginia

2. www.adrc-tae.org 2 Understand importance of reaching and serving private pay individuals as a priority in LTC system reform. Share with peers some best practices. Explore some challenges and potential ways to overcome roadblocks. Learning Objectives

3. www.adrc-tae.org 3 Who are Private Pay Consumers? People with some level of financial resources to devote to long term care services and supports People with incomes above poverty threshold People who are not currently eligible for public long term care programs Private pay ≠ wealthy

4. 4 U.S. Residents by Age% Below 100% of Poverty Threshold % Below 200% of Poverty Threshold % Below 300% of Poverty Threshold All Ages12.3%30.5%48.0% Ages 18-6410.8%26.2%42.5% Age 21-64 with Disability**25.4%-- Over Age 659.4%35.4%57.3% Over Age 65 Living Alone16.9%56.8%75.6% Source: U.S. Census Bureau, Current Population Survey, 2007 Annual Social and Economic Supplement. ** Source: U.S. Census Bureau, 2006 American Community Survey

5. www.adrc-tae.org 5 Estelle $15,000/yr from Social Security and small pension Modest savings but no LTC insurance Widowed for several years Lives alone in a rural area, no longer drives Experienced a fall recently, multiple fractures limit her ability to care for herself like she used to Growing isolation and depression Children live several states away and are increasingly concerned

6. www.adrc-tae.org 6 Private Pay Elements in Network Programs Core programs Older Americans Act Reauthorization Title II Section 202(b) Aging and Disability Resource Centers “…visible and trusted places where people of all incomes and ages can turn…” Community Living Programs Targeting consumers not eligible for Medicaid Veteran Directed Home and Community-Based Services Providing self-directed HCBS to qualifying veterans, financed by Veterans Health Administration

7. www.adrc-tae.org 7 Why Serve Private Pay Consumers? Individuals and families with all levels of income need unbiased, reliable information and counseling ADRCs/AAAs can help families with private resources use those resources more wisely, which may delay or prevent “spend- down” to Medicaid or unnecessary institutionalization Potential for financial or in-kind resource contributions to ADRC/AAA operations Employers and insurers are purchasing services that ADRCs/AAAs can provide through options counseling Serving more people results in greater community impact The use of ADRC/AAA services by all types of residents in a community helps build support and achieve sustainability

8. www.adrc-tae.org 8 Approaches to Serving Private Pay Offer standard services free of cost to PP consumers Example: Information and Assistance, Options Counseling May require changes to I&A database, intake and assessment processes, etc Provide services directly to PP consumers Donations Sliding Scale Cost Sharing Fee for Service

9. www.adrc-tae.org 9 Almost 24% of AAAs offer services on a fee- for-service or cost-sharing basis, but almost 65% of AAAs have no plans to do this. What is the Network Doing Now? 52.4% are “sometimes” in touch with populations that say they are not eligible for public programs but able to pay for some of the services on a sliding fee or reduced fee basis. While 44% of respondents agreed with the statement that they have the right subject matter expertise and are confident in discussions with private pay consumers… Only about 40% agreed that they had the proper partnerships or adequate information in their resource databases to serve private pay consumers.

10. 10 31 2 Where Does Your Organization Fit?

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12. 12 Building Capacity to Serve Private Pay Contextual Conditions for ADRCs Target Pop. Needs Assess. Policy Changes Required Practice Changes Required Short - Term Benefits Long -Term Outcomes

13. www.adrc-tae.org 13 TAE Resources On-line Trainings http://www.adrc-tae.org/tiki-index.php?page=Training Making a Profit in a Non-Profit World (CEU credits available) Reaching and Serving Private Pay Consumers NASUA Issue Brief “Supporting the Information Needs of Private Paying Consumers” http://www.adrc-tae.org/tiki- download_file.php?fileId=28259

14. www.adrc-tae.org 14 Technical Assistance Exchange www.adrc-tae.org The Lewin Group | Health care and human services policy research and consulting | www.lewin.com www.lewin.com 3130 Fairview Park Drive, Suite 800 Falls Church, VA 22042 From North America, call toll free: 1-877-227-5042 inquiry@lewin.cominquiry@lewin.com The Lewin Group is an Ingenix Company. Ingenix, a wholly-owned subsidiary of UnitedHealth Group, was founded in 1996 to develop, acquire and integrate the world's best-in-class health care information technology capabilities. For more information, visit www.ingenix.com. The Lewin Group operates with editorial independence and provides its clients with the very best expert and impartial health care and human services policy research and consulting services. The Lewin Group and logo, Ingenix and the Ingenix logo are registered trademarks of Ingenix. All other brand or product names are trademarks or registered marks of their respective owners. Because we are continuously improving our products and services, Ingenix reserves the right to change specifications without prior notice. Ingenix is an equal opportunity employer. Original © 2008 Ingenix. All Rights Reservedwww.ingenix.com Christina Neill Bowen Deb Merrill The Lewin Group National Association of State Units on Aging Training Coordinator State LTC Ombudsman Resource Center Partner Christina_neill@yahoo.comChristina_neill@yahoo.com dmerrill@nasua.org 703-269-5637 202-898-2578