Recent headlines regarding the recent Medicaid cuts to Illinois long-term care providers only tell a portion of the dramatic story unfolding. Of course, for skilled nursing home providers, the reduction in Medicaid reimbursement is not welcome news, but ultimately no long-term care facilities will close as a result of this round of Medicaid cuts and balance sheets will remain stable. However, a little reported component of the recent budget cuts, causes worry among those who advocate for less institutional care for Illinois' older adults.
Reviewed in a prior post (here), in Illinois the Community Care Program (CCP) serves people age 60 and older and uses the Determination of Need (DON) tool to determine program eligibility and allocate services dollars. CCP is one of the largest programs of its kind in the nation, caring for 75,000 clients and growing at a fast pace (50% between 2004 and 2009).
A 2009 study prepared for the Illinois Department on Aging (which manages the program) determined that CCP is a "good deal" allowing a large number of frail oder adults at risk for nursing home placement to remain in the community at lower cost per person then if living in a nursing home. Unfortunately, the recent Medicaid cuts included raising the minimum DON score needed to access CCP, from a score of 29 to 37 (out of a scale of 0-100). Based upon utilization statistics published in 2009, approximately 22% of CCP clients will be no longer be eligible for this entitlement program. If I were a betting man, I would put money on the likelihood that a lawsuit will be filed any day to prevent IDoA from implementing this change by providers belonging to the Life Services Network and the Health Care Council of Illinois. For elder care service providers, who cannot afford to provide uncompensated care, they can only offer best wishes and empathy to those older adults for whom these services are vital.
Meanwhile, research reported in the June edition of Health Affairs magazine reveals a disturbing trend of older adults being placed in "observation" status when in a hospital rather then being admitted.
the ratio of observation stays to inpatient admissions increased 34 percent [emphasis added], from an average of 86.9 observation stay events per 1,000 inpatient admissions per month in 2007 to 116.6 in 2009
To qualify for the Medicare covered stay in a skilled nursing facility, a Medicare enrollee must spend at least three consecutive midnights (i.e. the three-day rule) as an admitted inpatient in a hospital. Observation stays in a hospital are not sufficient to qualify for a Medicare covered stay in a long term care facility.
These unfavorable trends reflect the increasing pressure on government budgets and health care providers as they struggle to cope with a rapidly aging population. Regardless of whether cost containment measures are instituted by providers or legislators, the net effect on older adults and on those who who care for them are the same: you are on your own.
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