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GIVE THE GIFT OF VOR THIS HOLIDAY SEASON!!!
A donation in someone's honor makes a perfect Holiday gift, or give the
gift of VOR membership. Use the form at the end of this weekly update or
contact Tony Padgett, VOR's Director of Resource Development at
anthonypadgett@sbcglobal.net, or 847-253-6020 with any questions. Thank you
for your support and HAPPY HOLIDAYS!!!
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VOR is the only national organization advocating for a full range of
residential and support options for people with mental retardation,
including Medicaid-certified Intermediate Care Facilities for the Mentally
Retarded (ICFs/MR) and home and community-based care. VOR supports choice.
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VOR Weekly E-Mail Update
December 15, 2006
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1. Medicaid's Long-Term Care Beneficiaries
2. Medicaid Commission Update: Panel Calls for Big Changes in Medicaid
3. VOR Rebuttal: What (MR/DD) Institutional Bias?
I. INTRODUCTION
II. MY FOCUS TODAY -- WHAT INSTITUTIONAL BIAS?
III. A NOTE ABOUT MEDICAID EXPENDITURES
4. Give the gift of VOR! A great way to honor your loved ones with a
meaningful gift, while also benefiting a great organization - VOR!
Coming Up: Focus on Access to Health Care and Related Services
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1. Medicaid's Long-Term Care Beneficiaries
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Urban Institute's Health Policy Newsletter
November 30, 2006
In a paper released by the Kaiser Commission on Medicaid and the Uninsured,
Anna Sommers, Mindy Cohen, and Molly O'Malley present spending patterns of
Medicaid beneficiaries who received long-term care services. Using 2002
data from the Medicaid Statistical Information System Summary File, they
found that Medicaid long-term care users accounted for 7 percent of the
Medicaid population in 2002 but over half of total program spending. Three
quarters of this spending went toward long-term care and 25 percent was
devoted to acute care and other supportive services. Beneficiaries dually
eligible for Medicare and Medicaid accounted for two-thirds of Medicaid
enrollees who used long-term care and a similar share of Medicaid spending.
Apart from the elderly and disabled, about 400,000 non-disabled children
and 1.1 million non-disabled adults under age 65 used long-term care
services in 2002. Entire Report <http://www.kff.org/medicaid/7576.cfm.
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2. Medicaid Commission Update: Panel Calls for Big Changes in Medicaid
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Summary: The panel said Congress should rewrite the Medicaid law to
encourage the use of home care and community services, instead of nursing
homes and other institutions. In an interview, Angus King, the former Maine
governor who is the panel's vice chairman, said: "We need to reverse
Medicaid's institutional bias. Community care that's what people want.
It's better for beneficiaries. And it's less expensive." The panel urged
the Bush administration to study a novel idea: increasing federal subsidies
for low-income groups added to the Medicaid rolls, while scaling back
subsidies for higher-income people added to the program. The panel said
this would help achieve "Medicaid's core purpose," serving low-income
people. For more Medicaid Commission issues, see
http://www.aapd.com/News/commission/indexmedcomm.php.
Panel Calls for Big Changes in Medicaid
by Robert Pear
The New York Times
Nov. 22, 2006
WASHINGTON, DC - A federal advisory panel says that long-term care for
aging baby boomers threatens to bankrupt Medicaid, and it recommends
sweeping changes to rein in costs, including greater use of managed care
for the sickest Medicaid recipients.The proposals set up a likely clash
between the new Democratic Congress and the Bush administration, which has
sent strong signals that it will seek big savings in Medicaid next year.
Panel members adopted the recommendations last week, by a vote of 11 to 1,
and are drafting a report to be submitted next month to Michael O. Leavitt,
the secretary of health and human services. Mr. Leavitt created the panel
in May 2005 and is receptive to many of its proposals.
The panel, known as the Medicaid Commission, said states should have more
freedom to alter benefits and eligibility for the program, which serves
more than 50 million low-income people.
Moreover, it said states should be allowed to enroll some of the sickest
Medicaid recipients, including nursing home residents and people with
disabilities, in managed care plans.
The panel said such plans "would provide a medical home and better
coordinated care" for people entitled to both Medicaid and Medicare. Care
is often fragmented now because Medicaid pays nursing homes while Medicare
is the primary payer for doctors and hospitals, and in many cases "clinical
data is not shared," the panel said.
People enrolled simultaneously in the two programs account for 13 percent
of Medicaid recipients, but more than 40 percent of Medicaid costs.
Medicaid, which is financed jointly by the federal government and the
states, covers two-thirds of the nation's 1.6 million nursing home
residents.
"The anticipated costs for long-term care services in this country threaten
the future sustainability of the Medicaid program," the panel warned. It
recommended that the federal government and the states provide new tax
incentives for people to buy private insurance covering the costs of
long-term care, so they would not rely so much on Medicaid.
"Public policy should promote individual responsibility and planning for
long-term care needs," said the panel, led by former Gov. Don Sundquist of
Tennessee, a Republican.
More generally, the panel said states should be free "to consolidate or
redefine eligibility categories" and should be given "greater flexibility
to design Medicaid benefit packages."
The proposals drew a swift negative response from Democrats who will be
responsible for Medicaid in the new Congress. Representative John D.
Dingell of Michigan, who is in line to become chairman of the Energy and
Commerce Committee, dismissed the panel as "a hand-picked commission
stacked against working families."
Senator Max Baucus of Montana, the Democrat in line to lead the Finance
Committee, said many of the proposals would make it more difficult for "the
most vulnerable Americans" to get comprehensive care.
John C. Rother, policy director of AARP, the lobby for older Americans,
said, "In some states, flexibility means cutting benefits."
But Christina Pearson, a spokeswoman for Secretary Leavitt, said, "He
definitely supports more flexibility for states to meet the needs of
different population groups."
Grace-Marie Turner, a commission member, said, "People who rely on both
Medicaid and Medicare are the most vulnerable beneficiaries, but in most
cases, nobody is coordinating their care." Even if a state wants to place
them in managed care, it may take months or years to get federal approval,
said Mrs. Turner, who is president of the Galen Institute, a research
center focusing on health policy.
The commission said states should be able to place all types of Medicaid
recipients in managed care without getting "a waiver or any other form of
federal approval." But, it said, individuals should be able to "opt out" of
managed care.
Gwendolyn G. Gillenwater, a commission member who is policy director of the
American Association of People with Disabilities, an advocacy group, voted
against the report.
"People with disabilities have not had good experience with managed care,"
Ms. Gillenwater said. "We need federal protections and safeguards. People
with disabilities should at least have a choice of two managed care plans.
And what are your choices if you opt out of managed care? The alternatives
are getting more and more limited."
The panel said Congress should rewrite the Medicaid law to encourage the
use of home care and community services, instead of nursing homes and other
institutions.
In an interview, Angus King, the former Maine governor who is the panel's
vice chairman, said: "We need to reverse Medicaid's institutional bias.
Community care that's what people want. It's better for beneficiaries. And
it's less expensive."
The panel urged the Bush administration to study a novel idea: increasing
federal subsidies for low-income groups added to the Medicaid rolls, while
scaling back subsidies for higher-income people added to the program. The
panel said this would help achieve "Medicaid's core purpose," serving
low-income people.
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3. VOR Rebuttal: What (MR/DD) Institutional Bias??
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Summary: The following testimony was delivered by Robin Sims, VOR's second
vice president, at the final Medicaid Commission hearing in November in
Arlington, Virginia. VOR participated in a total of 5 Medicaid Commission
meetings, providing testimony relating to the need for a full array of
residential options, including facility-based care, community quality
concerns, the potential of the Community Resource Center model, and the
myth of an institutional bias. Special thanks to Irene Welch (Georgia),
Nancy Ward (Texas), Patricia Bennett (Virginia), Mary Reese (Maryland), and
Robin Sims (New Jersey) for representing VOR at these meetings.
VOR Statement to the Medicaid Commission
November 2006
by Robin Sims, Second Vice President
DISPELLING MEDICAID MYTHS
I. INTRODUCTION
My name is Robin Sims.
I am the First Vice President of VOR, a national nonprofit advocacy
organization for people with mental retardation and their families. I hope
that by now, VOR and our perspective is familiar to you. You have heard
from VOR representatives in Atlanta, Georgia; Irving, Texas; and twice
before today in Arlington, Virginia.
As with the VOR representatives who have testified before me, I come today
as a volunteer. Our support for VOR's perspective is motivated by our
common link: We all have family members with mental retardation who need
Medicaid services.
In my case, I have 2 children with disabilities. Although their needs are
very different, both are thriving in their own way Heather is 23 years old
and has a regressive form of autism. She has lived in an ICF/MR in Clinton,
NJ called the Hunterdon Developmental Center for the past 8 years. She
needs constant supervision and assistance with all her self- care needs.
She has violent outbursts and requires the expertise of a trained staff to
keep her from hurting herself and others. While she has made some
improvement since her admission to Hunterdon, it is due to the consistency
and predictability of the environment. Without her Medicaid-funded ICF/MR
placement she would not have survived. Benny is now 20 years old and has
Fragile X Syndrome. As he ages out of school services it is unknown what
kind of work or programming will be appropriate for him. His father and I
have seen many other kids like Benny with no services after transition and
the results have been from severe depression, regression and even death.
II. MY FOCUS TODAY -- WHAT INSTITUTIONAL BIAS?
My focus today will be the myth of an institutional bias, with regard to
Medicaid expenditures, for persons with mental retardation and
developmental disabilities.
It is critically important to me and VOR that each Commissioner understand
the very different populations receiving Medicaid long-term care and do
not, in addressing an alleged bias, inadvertently negatively impact people
with mental retardation who have nothing to do with the institutional bias.
VOR has a legitimate reason to be concerned. At a recent meeting, a member
of this Commission stated publicly that the Commission had agreed
unanimously to eliminate the institutional bias.
I'm hopeful that my brief remarks today, along with VOR's written
presentation received by Commissioners in advance of this meeting, will
help explain why the allegation of a Medicaid institutional bias for people
with MR/DD is simply not true.
There is no Medicaid "Institutional Bias" for Persons with Mental
Retardation and Developmental Disabilities (MR/DD)
The origin of this myth relates to two factors.
The first is the historical combining of figures for the nursing facility
program with the ICF/MR program to comprise a total figure for
"institutional spending." This co-mingling of people and services throws
together people with MR/DD and the services they require with the much
larger physically-disabled demographic -- including the elderly -- and the
services they require.
The second is labeling all "institutional" services as mandatory and all
community services as "optional." As a matter of fact, nursing facility
care is mandatory but ICF/MR care and community care are both optional
Medicaid services.
Separating out ICF/MR funding from nursing home care "institutional"
figures and comparing just the funding for people with MR/DD leads to
dramatically different conclusions.
A) ICFs/MR comprise only 20% of total Medicaid "institutional" spending.
Nursing Facilities (NFs) (also called "nursing homes") account for 80% of
total Medicaid "institutional" spending.
B) Furthermore, when funds for persons receiving MR/DD services are
separated out, only 25.8% of total Medicaid dollars goes to ICFs/MR (MR/DD
institutions) while 74.2% is spent for MR/DD community-based services.
Stated another way, we spend almost 3 times as much on Medicaid home and
community-based services, and compared to MR/DD institutional services.
C) From 1977 to 2004, overall fiscal commitment ("fiscal effort") to
community programs, as measured by the total amount spent from state and
federal sources for MR/DD services per $1,000 of citizens' personal income,
increased by 486%. In contrast, institutional spending declined by 51%
(Figure 3).
III. A NOTE ABOUT MEDICAID EXPENDITURES
On a related note, it is important also for Commission members to recognize
that ICFs/MR are not the cause of rising Medicaid costs. The ICF/MR program
is a tiny and falling percentage of all Medicaid funding and a good
investment for both the federal government and the states to care for their
most needy citizens. I know; my daughter is a benefactor of the good care
received in a state ICF/MR. There is no doubt in my mind that the
availability of ICF/MR supports saved her life and brought sanity and peace
to my family home.
Consider these figures, relating to Medicaid expenditures. From 1995
through 2005 --
* Medicaid increased by 98.28%
* Community increased by 267.5%
* ICF/MR increased by only 25.9%
IV. CONCLUSION
The myth of an "institutional bias" in Medicaid -- spending more on
institutional services than community services -- coupled with Medicaid
"rebalancing" initiatives, as applied to services for persons with MR/DD,
can have dangerous consequences for our most fragile citizens.
Federal and State efforts to "rebalance" the system by increasing community
supports at the expense of "institutional" (including ICF/MR) options,
places at risk the ICF/MR option. ICFs/MR may become uneconomical and
extinct, risking the health, safety and very lives of people with severe
and profound mental retardation.
The most fragile people of the MR/DD population are not going away. Their
specialized care needs will continue to exist at the same or greater level
into the future. Their care will continue to be expensive regardless of
where they are being served; some studies suggest the cost of care could be
higher in community settings for the most disabled and medically-fragile of
our society.
While there is an ongoing need to expand community-based options, it is
short-sighted and morally indefensible to do so at the expense of an
exceedingly fragile population.
Thank you for your time today.
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4. Give the gift of VOR! A great way to honor your loved ones with a
meaningful gift, while also benefiting a great organization - VOR!
---------------------------------------------------------------------------
A donation in someone's honor makes a perfect Holiday gift, or give the
gift of VOR membership.
A Tribute donation of any level will result in your honoree's name being
included in the next issue of The Voice, in the Tribute Donation section.
VOR also now offers special tribute categories allowing you to dedicate an
entire issue of a VOR Weekly E-Mail Update ($100), or an issue of the
quarterly newsletter, The Voice ($1000). With your gift of $100 for a
Weekly Update, or your gift of $1000 for a printed issue of The Voice, the
issue will be prominently dedicated to the person of your choice and a
small article about that person will be included in the issue. This is a
great holiday gift idea; they will feel special!
The gift of a VOR membership - just $25 - is also a great holiday gift.
Soon after the receipt of your gift, the new member will receive a copy of
the latest newsletter, along with a note sharing that they are receiving
this membership due to your generosity.
These are great holiday gift ideas that also benefit VOR. Use the form at
the end of this weekly update or contact Tony Padgett, VOR's Director of
Resource Development at anthonypadgett@sbcglobal.net, or 847-253-6020 with
any questions.
Thank you for your support and HAPPY HOLIDAYS!!!
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Tamie Hopp
REFERRAL/MEMBERSHIP/CONTRIBUTION FORM
THREE EASY WAYS TO SUPPORT VOR > REFER, CONTRIBUTE OR JOIN
THANK YOU FOR YOUR SUPPORT!
TO JOIN OR CONTRIBUTE: $25 per individual, $150 per family organization, or
$200 per provider/professional organization. Extra donations are welcome!
You may pay by credit card or check.
TO REFER SOMEONE TO VOR: Use the form below, including the additional
sections for referrals.
Mail the completed form (if joining or contributing) with payment to:
Voice of the Retarded
5005 Newport Drive, Suite 108
Rolling Meadows, IL 60008
847-253-6054 fax (for referrals or credit card payments)
vor@compuserve.com (for referrals or credit card payments)
FOR REFERRALS: ____ The contact information provided is for someone I
think would consider membership with VOR.
FOR REFERRALS: _____ You may use my name in any correspondence with this
individual. My name is ________________________.
____________________________________________
Name
_____________________________________________
Address (if paying by credit card, use billing address). All forms must
include complete address including zip code)
_____________________________________________
City St Zip
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Phone Fax
_____________________________________________
E-Mail
_________________________________________________
Family/Professional Organization Affiliation (if applicable)
VOR now accepts Master Card and Visa. If paying by credit card, please
provide the following information:
Amount to charge to card:
___$1,000 ___$500 ___$250 ___$150 ___$50 ___$25 $_____ Other amount
_____ Master Card
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Card Number: ___________________________________
Expiration Date: __________________________________
Cardholder's Signature: ___________________________
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