1. Alecxih Projecting Need for Long Term Care: Estimating the Potential HCBS Population Lisa Alecxih Center on Long Term Care The Lewin Group 1

2. Alecxih 2 OverviewOverview F Why develop estimates? F The Lewin Group's Center on LTC's HCBS population tool F Going beyond the HCBS population tool

3. Alecxih 3 Why Develop Estimates? F Desire to expand or contract services F Wait list management F Olmstead planning

4. Alecxih 4 HCBS Population Tool F Tool for estimating individuals potentially eligible under alternative criteria Age Level of disability Income as a percent of the poverty level F Can vary by States and year

5. Alecxih 5 HCBS Population Tool Entry Screen

6. Alecxih 6 HCBS Population Tool Output Screen

7. Alecxih 7 Data Sources F National level data on specific disabilities Survey of Income and Program Participation (SIPP) F State level data on age, income and broad measures of disability 1990 Census Public Use Microdata Sample (PUMS) re-weighted to reflect 2000 age and income distribution by State 2000 Census individual level data expected to be available next Summer

8. Alecxih 8 Disability Definitions F ADLs – “require the help of another person” to perform the following: Bathing, dressing, eating, transferring, using the toilet, and getting around inside the house F IADLs – “needing the help of another person” with the following: Paying bills, taking medication, using the telephone, getting around outside the house, doing light housework, and preparing meals

9. Alecxih 9 Disability Definitions (cont.) F MR/DD – self-/proxy-reported condition F Severe Mental Illness (SMI) – self-/proxy- reported mental or emotional condition that “seriously interfered with ability to manage everyday activities,” (except MR/DD, AODA[abuse of drugs and alcohol], Alzheimer’s) F The MR/DD and alternative functional limitation categories are mutually exclusive; the SMI category overlaps F Assumed constant disability rate between 1990 and 2010 conditional on age, state, and income

10. Alecxih 10 CaveatsCaveats F No estimates for children under age 6 F No IADL(instrumental activities of daily living) or SMI/SED estimates for children age 6-14 F No definitive group for institutional level of care F No asset information for financial eligibility

11. Alecxih 11 Going Beyond the HCBS Population Tool F Smaller geographic detail F Estimating participation F Incorporating current users F Estimating amount of use

12. Alecxih 12 Smaller Geographic Detail F Same methods can be used to produce MSA or county level estimates F Useful for more detailed state planning or systems that are county-based

13. Alecxih 13 Incorporating Current Users F State reports for the number of unduplicated users Ideally monthly by age and disability Point-in-time versus throughout the year issues F Calculate a current participation rate F Provide sense of remaining potential demand

14. Alecxih 14 Estimating Participation F Not everyone who might meet criteria will necessarily choose to use services F However, some individuals that do not meet the functional criteria based on survey data may actually qualify

15. Alecxih 15 Estimating Amount of Use F Simplest – use average annual or monthly use under current programs F More elaborate – develop estimates of use that vary based on level of disability, age, other factors F Need to consider current scope of services relative to planned scope

16. Alecxih 16 SummarySummary F HCBS Population Tool available at www.lewin.com F Planners can use this basic information or be more elaborate F Need to perform reality checks