I've worked in the Illinois elder care industry for over 20 years and I can state without equivocation that the Illinois budget process has never been particularly pretty. Like sausage making, one tries to concentrate on the end result rather than on what it takes to get there. For 20 years, there were insufficient appropriations to Medicaid with no corresponding programatic cuts.
In good economic times (and bad) assuring long term services and supports for Illinoisans who require financial assistance is a "difficult". Competing for limited resources often leads to battles between various constituencies as they struggle to assert the preeminence of their service delivery model (and protect their revenues).
The budget battle for FY 2013 is only just beginning and to quote from the film All About Eve, "Fasten your seat belts. It's going to be a bumpy ride." Director of Illinois Healthcare and Family Services (HFS), Julie Hamos recently reported that the HFS budget is in bad shape (a dramatic understatement), the structural deficit must be addressed and implementing cost containment measures must be considered to restore solvency to the program. Driving the sense of urgency is a $1.5 billion budget shortfall identified in May 2011 and the other is the continued increase in Medicaid enrollment (currently 2.7 million persons). HFS anticipates a $2 billion deficit by the end of this fiscal year and that means that tough choices need to be made. Of course, constraints in the federal budget are also impacting this discussion. The feds are pushing for a major realignment of how medical costs are reimbursed for "dual eligible participants" (i.e. those older adults who qualify for both Medicare and Medicaid coverage) to be implemented by January 1, 2013. The scale and timing of this project creates enormous challenges for HFS and only adds to the overall sense of gloom which hangs over the head of every everyone at HFS.
Long Term Care Services and Supports:
Let's be clear, it is now March and only those Medicaid providers who qualify for expedited payment have been paid at all in the current fiscal year. Seriously. This is bad. Really bad. Frankly, we are entering a new era and the repercussions for the elder care industry in Illinois will be profound. Among the cost containment strategies on the table are:
- Requiring a determination of need score (DON) of 37, up from the current 29 in order to receive Medicaid community based services. Those who do not score at 37 or higher would not be eligible for services. Based upon 2009 data, approximately 21% of recepients (12,000 individuals) have DON scores between 29 and 37. The DON tool is an assessment of a person's ability to perform essential and instrumental activities of daily living.
- Requiring a DON score of 37 in order to reside in a supportive living facility (SLF) or a nursing facility as a Medicaid recipient. Similar to the bullet above, those who do not score 37 on this assessment tool would not be eligible to reside in a SLF as a Medicaid recipient. Approximately 66% of those individuals living in Illinois SLF's are receiving Medicaid support. Supportive living facilities are an alternative to nursing homes for low-income older adults.
- Rate reductions to providers, elimination of services (e.g. hospice), moratoriums on new admissions to supportive living facilities and for intermediate care nursing home clients are all on the table for consideration.
Where this leaves us is anyone's guess. The Governor and his directors have presented their case to the legislature during the past weeks and the political process now begins in earnest. I'll leave the handicapping of possible outcomes to others with greater insight into the machinations of Springfield politics. One thing is certain. Dramatic change is coming and the various stakeholders have much at risk. What are your thoughts?
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