1. A View from Washington State 1 Community First Choice Option 1915(k) Requires additional services in tandem with personal care -- training to accomplish ADL’s, backup systems; employer functions Includes optional services: transition costs (damage deposits, household goods) and services that substitute for human services (e. g. electronic medication reminder) 6% additional FMAP is attractive MOE on state funds for the first year is a concern that needs to be carefully evaluated in current budget climate Washington is looking to the possibility of moving its Medicaid Personal Care population and possibly some 1915(c) waiver clients to 1915(k) The current budget situation requires any move be contingent on not spending more state funds We are currently modeling cost projections and awaiting further federal guidance

2. A View from Washington State 2 1915 (i) Option The most attractive aspect was the ability to cap enrollment Allowed targeted expansion of options without creating a new entitlement In these financial times removal of the ability to control growth means there is little advantage In this budget climate that outweighs other positives: -- Ability to target specific groups -- Ability to reach people before they reach institutional levels of care The same array of services can be offered under a 1915 (c) waiver

3. A View from Washington State 3 Better Coordination Of Service to Duals Better coordination between the federal government and states will improve access and quality of care Washington’s fee-for-service long-term care system under Medicaid supports 17,000 of the most medically expensive people for the state and federal government. About two-thirds of those are duals In Washington State we have made extraordinary efforts to manage long-term care costs and have recently looked more closely at how our efforts affect medial costs We’ve proven in limited pilots that what happens in long-term care can positively affect bottom-line medical expenditures Bringing those efforts to scale to the benefit of all will require joint federal and state efforts to design and test new models for delivery and payment