Medicaid and home based services in Illinois (Part IV)

The Medicare and Medicaid programs were signed into law by President Johnson on July 30, 1965. Almost 50-years later, many use the names of the two different programs interchangeably. Big mistake. Medicare (for the purposes of this blog) is the federal health insurance program for people 65 and older. Medicaid is health coverage available to individuals (and families) who have limited income.

In Illinois

The Illinois Department on Aging (IDoA) is responsible for providing assistance to older adults living at home with support support services (here). The State Plan on Aging for FY2010-2012 lists as its first goal to:

"Rebalance Illinois' long-term care system to expand in-home and community-based services to enable seniors to remain in their own home with high quality of life for as long as possible."

Since 1979, IDoA's  Community Care Program (CCP) has helped senior citizens remain in their own homes by providing in-home  and community based services. As you can imagine, dear reader, in these times, this is a very difficult challenge. The CCP program is funded in part with Federal Medicaid money as well as with Illinois Medicaid funds.

Participation in the CCP is limited to those citizens (or lawful permanent residents) who are over the age age of 60. Accessing the CCP program first means contacting an agency, which will evaluate the client using the Determination of Need" (DON) tool to establish the client's DON score. The DON measures cognitive functioning as well as independence with activities of daily living and independent activities of daily living. The minimum score is 29 to qualify and the higher the score the more services will be made available.

If the client's monthly income is below the poverty level (non-exempt assets below $10,000), the client will not need to contribute to the cost of the CCP services. If the income is too high, there may be a contribution or the client may even be deemed ineligible for the program.

The Challenge:

The average annual cost for a CCP participant is $11,000 (average annual cost for a SNF resident is $42,705). On its face, the savings justify expanding CCP participation; however, multiple challenges exists to the program's expansion. Firstly, many potential CCP participants suffer from housing insecurity and an unexpected (lengthy) hospitalization may result in the loss of their residence. There currently exists no funds for re-establishing community residence.  Also, although this program is funded by both federal and state governments, the current economic climate inhibits the growth of the program. Approximately 75% of the funds for this program are allocated from the Illinois General Revenue Fund (GRF) and CCP is one of only many programs funded from the GRF. The Governors Conference on Aging will be held in December and I would not be surprised if CCP funding and accessibilty continues to be discussed. What do you think?

Learn more on Twitter @aginginchicago

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    Bruce Lederman has over 25 years experience in the senior care field as a direct care provider and thought leader. Bruce was CEO and president of his own firm that operated skilled nursing facilities in Illinois. He is a former nursing home administrator and has consulted to numerous elder care providers on planning for strategic growth as well as process improvement. Recently he served as board chair of CJE SeniorLife, a leading non-profit elder care provider in the Chicago area. Bruce is currently employed as chief strategy officer for a company providing skilled nursing services in communities throughout Illinois and Missouri.

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