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Governor Rell Announces $24.2 Million Federal Grant to
Help Connecticut Residents Move from Nursing Homes
Governor M. Jodi Rell today announced that Connecticut is receiving a $24.2 million federal grant to pioneer new ways of helping people move from nursing facilities and other institutions to life at home with family and friends. The initiative has become known in Connecticut as Money Follows the Person.
“This represents a tremendous step forward in our efforts to help people with disabilities and their families,” Governor Rell said. “The idea is to use Medicaid dollars as flexibly as possible to give people more choices about their living situation.
“People depend on Medicaid eligibility to put a roof over their head and provide them with services. Now, we can help get more people home by arranging support like 24hour, inhome care, which Medicaid has not traditionally paid for.
“We want to do everything we can to help people achieve a more independent lifestyle. That means giving people more choices about their living situation. It means enabling them to return home to their families and their communities. This approach will be costeffective for taxpayers and lead to wonderful improvements in the quality of life for many of our seniors and people with disabilities.”
Connecticut’s grant application to the federal government, prepared by the Department of Social Services, projects that 700 people with disabilities will be able to transition from nursing homes to the community over the next five years. The federal funding will total $24.2 million during that period, with $1.3 million allocated for 2007.
Governor Rell praised the efforts of Southington resident Joseph Stango in championing the Money Follows the Person concept in Connecticut. “Joe’s work in raising awareness at the Legislature and throughout the state was critical in getting Money Follows the Person off the ground,” the Governor said. “His goal to bring his mother home to live with him is a true labor of love that now should help hundreds of Connecticut residents.”
The most notable expense to be newly covered by Medicaid through the initiative is 24hour, livein assistance. Also covered are personal management, home alterations to accommodate wheelchairs and other medical equipment needs and other support services.
Last year, the Governor and General Assembly authorized a state application for the ‘Money Follows the Person Rebalancing Demonstration Grant,’ as offered by the federal Centers for Medicare and Medicaid Services. Medicaid is jointly funded by the federal and state governments as a healthcare safety net for people with very low incomes and financial assets.
Under the Money Follows the Person initiative, the federal government will provide increased Medicaid funding, reimbursing the state for 75 percent of costs for the first year back in the community, instead of the customary 50 percent. Essentially, the enhanced federal support is a financial incentive for states to reduce reliance on expensive institutional care for Medicaid recipients.
The program will serve individuals with physical disabilities, mental illness and mental retardation, ranging in age from children to elderly. Options for residence in the community will include the person’s own home, a family home, apartment, and congregate housing such as assisted living.
Centers for Medicare and Medicaid Services Director Dennis G. Smith said, “We expect that these demonstration grants will greatly enhance [Connecticut’s] efforts to rebalance your longterm support system so that individuals have a choice of where they live and receive services.”
Governor Rell noted that the Money Follows the Person approval follows the recent federal award of a $5.1 million Medicaid ‘infrastructure grant’ to boost employment opportunities for citizens with disabilities in Connecticut.
In addition, the Governor noted a range of initiatives on behalf of people with disabilities in recent years, including:
* expansion of the Connecticut Home Care Program for Elders to include personal assistance services and assisted living initiatives;
* 40% increase of slots on Connecticut’s Personal Care Assistance Waiver;
* prioritization of HUD Section 8 and Rental Assistance Programs for those transitioning from institutions to community living;
* targeted initiatives for home modifications to make apartments available for individuals with disabilities, supported by state bond funding; and
* extension beyond age 65 of the state’s Medicaid buyin program (termed Medicaid for the Employed Disabled program) for working individuals with disabilities.
Bush wants inhome care for elderly, disabled
Monday, February 28, 2005
Knight Ridder Newspapers
Copyright © 2005 AP Wire
WASHINGTON The Bush administration believes it can improve services for Medicaid beneficiaries and help the program's shaky bottom line by caring for more elderly and disabled patients in their homes or through communitybased programs.
Experts say doing so is much cheaper than institutional care and allows some of Medicaid's most fragile patients to remain more selfsufficient.
"Anything that keeps a person out of a nursing home preserves their ability to maintain their dignity and their independence," said Dr. David Bean, a geriatric psychiatrist in Sioux Falls, S.D.
President Bush's 2006 budget proposal seeks $500 million over five years to move some of the disabled out of institutions and into these community programs. For patients who make the switch, the federal government would pay the entire cost of care in the first year and then split the cost with states anywhere from 50 to 70 percent in subsequent years.
While no similar money is earmarked for the elderly, the administration hopes to help states expand community services for a growing number of aging Americans.
The administration also wants Congress to allow states to offer those services to elderly and disabled Medicaid patients without federal approval.
Health and Human Services Secretary Michael Leavitt said expanding community care services gives patients more care options and saves money for Medicaid, the health plan for the poor and disabled that's paid for by the states and federal government.
Nationally, Medicaid has roughly 2 million patients in institutional care and about 1 million in community care programs. States that offer the services on a large scale, such as Ohio, Oregon and Vermont, have seen annual savings of up to $25,000 per patient over the cost of nursing home care.
"Providing the care that lets people live at home if they want is less expensive than providing nursing home care," Leavitt said. "Medicaid should not force these people to live in institutions."
But some feel the quality of the communitybased services could suffer if federal oversight is reduced and states, already burdened by rising Medicaid costs, use their new autonomy to cut program costs.
"This isn't being done to make Medicaid a better program. It's being done to cut the federal budget deficit, and we're concerned that they may be going too fast without talking about assuring that (patients) get appropriate services and whether they're going to be safe," said Janet Wells, the public policy director for the National Citizens' Coalition for Nursing Home Reform, an advocacy group for longterm care residents.
Kenneth Thorpe, chairman of the health policy management department at Emory University in Atlanta, agreed. "If you allow states a tremendous amount of experimentation with these home and communitybased programs, you have to have some examination that the services being delivered are of high quality and clinically effective." More than 70 percent of the state communitybased programs reviewed by the federal Centers for Medicare and Medicaid Services had one or more patient care problems, according to a 2003 report by the Government Accountability Office, the investigative arm of Congress. The most common were failure to provide necessary patient services, poor case management and inadequate patient care plans developed by caregivers.
The report also found that the Centers for Medicare and Medicaid Services doesn't hold the states accountable for submitting annual community program reports on time. In the past year, the agency has worked with its regional offices to improve program evaluations and improve the way patient satisfaction is measured, said administrator Mark McClellan.
Medicaid seniors such as Alice Terrell of Columbus, Ohio, are pleased about the idea of expanding homebased care because most seniors don't want to live in nursing homes.
"I just preferred to be at home with people that you know who care about you," Terrell said recently in her home. "It was just the idea of being around your friends and family."
Elderly and disabled advocates agree that, with proper patient support services such as meal delivery and transportation to medical appointments, communitybased care is a better option than nursing homes.
Just the prospect of entering a nursing home can send seniors into a depressive spiral, Bean said. "It's a major issue. They can't drive the car anymore. They could lose the home they've lived in for many years, their social network. These are all major losses."
States have offered communitycare programs for nursing homeeligible Medicaid patients since the early 1980s. Funding problems have limited enrollment, however, and waiting lists are common and likely to increase as the nation's elderly population grows.
Vermont saves about $25,000 a year per person by serving roughly 2,000 Medicaid patients in community programs instead of nursing homes. Since 1996, the state has used those savings about $50 million a year to expand the programs. Ohio pays an average of $12,600 a year for each of its 24,000 Medicaid patients in community care, compared with more than $55,000 for those in institutional care.
Officials in New Hampshire, hoping to reap similar savings, say their community care proposal will save the state $142 million over five years. In Oregon, about 20,000 nursing homeeligible patients are in community care; only 5,600 are in nursing homes. Homecare patients typically receive regular visits from a visiting home health aide who helps with some medical needs and other tasks such as bathing, meal preparation, household chores and errands. Patients with less severe needs often live at home and get medical and personal care at adult daycare centers.
Other communitycare services include assistedliving facilities and "boardandcare homes," which are smaller facilities, sometimes singlefamily homes, where three to 16 patients live. Still others are in adult foster homes, where private families are paid to provide their care.
A wheelchairbound survivor of two strokes, Terrell chose communitybased care instead of a nursing home.
For four hours each day, Frances McDaniel works as Terrell's home care aide, helping her with meals, hygiene and housekeeping. Terrell entered the program three years ago after surgery to implant a pacemaker. She has no regrets. A retired nurse in her 70s, McDaniel is close in age to Terrell, and the two are friends who call each other "Miss Alice" and "Miss Frances." "We've grown on each other," Terrell said. "I don't know what I'd do without her," McDaniel replied. "She's almost like family."
When run properly with strong support services, patients do better in communitybased care, said Rick Harris, director of the Alabama Bureau of Health Provider Standards, which regulates the state's nursing homes. But he said the quality of care could suffer if the programs expand and the state and federal oversight doesn't keep pace. "The question is are we willing to put the time, money and resources into the regulation of these programs?" Harris said. "It's just something that needs an awful lot of study."
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