Medicaid Services Expand in California

A couple of weeks ago, exciting news from California created buzz among Illinois providers of community based care for older adults and people with physical disabilities.

On September 4, California's Health and Human Services Agency announced (here) that it is the first state to obtain regulatory approval for implementing the Community First Choice (CFC) option, a new federally funded program aimed at keeping elderly and disabled individuals out of nursing homes. The CFC option will provide the state with an estimated $573 million in additional federal funds during the first two years of implementation allowing it to continue to prioritize an individual’s ability to reside in their community rather than in institutional care.

“We look forward to working with our state and federal partners as we move to provide seniors and people with disabilities with better options for self-directed care.” said  the California Health and Human Services Secretary Diana S. Dooley.

The CFC option is financed by  Medicaid and is made possible by the Affordable Care Act. It provides participating states a six percentage point increase in federal Medicaid matching funds for providing community-based attendant services and supports to beneficiaries who would otherwise be confined to a nursing home or other institution.

Since the mid-1970's, states have had the option to offer personal care services under their Medicaid state plans, but it had a  medical orientation and could only be provided in an individual's place of residence. Personal care services were mainly offered to assist individuals in their performance of activities of daily living, and, if incidental, to the delivery of such services could include housekeeping activities (and other chores).

In 1981, Medicaid (through the 1915(c) HCBS waiver program) has afforded states considerable latitude in designing services to meet the needs of people who would otherwise require institutional care. In 2010, nearly 1 million elderly and disabled individuals received LTSS in their homes or alternative residential community settings (nationwide, 1.4 million individuals reside in nursing homes).

It is not surprising that California beat Illinois to exploiting this resource for federal dollars to expand long term services and supports (LTSS). In last year's ground breaking AARP report, "Raising Expectations: A State Scorecard on LTSS" the data revealed  that California leads Illinois by a wide margin in providing choice of setting and provider for LTSS for older adults and people with physical disabilities. This latest development will surely only widen the gap as Illinois struggles with addressing its historic reliance on institutional-based care. A comparison of a few salient metrics reveals the extent of the gap between elder care delivery (to the Medicaid population) in California compared to Illinois.

% of Gorvernment funded LTSS going to home care % of Nursing Home Residents with Low Care Needs Number of Nursing Home Residents
2009 Rank 2007 Rank 2010
California 53.70% 6 10.80% 19 101,854
Illinois 27.90% 29 25.10% 49 74,721

There are many explanations for the disparities which exist between the Land of Lincoln and the Golden State. In Springfield, disparate (and often competing) stakeholder interests and a chronically underfunded Medicaid program complicates regulatory initiatives and reforms. Of course, California faces its own budget challenges and for that reason some may marginalize the viability its initiatives in this area.  I  disagree with those naysayers. The goal of maximizing the choice and control older adults have over their lives remains paramount. Although it may not be achieved quickly in Illinois, at least we can see evidence that it can be done.

What do you think? Learn more on Twitter at @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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