Steve Gold, The Disability Odyssey continues
Medicaid data for FY 2006 provides extremely helpful information to
analyze and compare how your State distributes and allocates its Medicaid
Long Term Care expenditures between its institutional versus
community-based services.
Nationally, for all disabilities, 60.6 % of MA's long term care
expenditures went to institutions, i.e, both to nursing homes (for
disabled persons of all ages, "PD/A," physical disabilities/aged) and to
intermediate care facilities (for persons with "MR/DD," mental
retardation/ development disabilities). In contrast, 39.4% of all MA's
long term care expenditures went for community services, i.e., for waivers
(i.e., both PD/A and MR/DD), personal care option, and home health
services in the community.
To understand the balance or ratio, think of a scale, with nursing homes
and ICF MR/DD on the side, representing institutional expenditures, and,
on the other side of the scale, with waivers, personal care and home
health services, representing the community-side expenditures.
To have a clearer or more accurate picture of the scale, it's necessary to
break down and compare specific institutions with specific community
services.
When disabilities are broken down by MR/DD and PD/A, a dramatic difference
exists in the 60.6 % national long term care distribution.
For persons receiving MR/DD services, nationally only 39.3% went for
institutions (ICF-MRs) and 60.7% was spent for community-based services.
That's correct: less Medicaid funds go to institutionalize persons with
MR/DD in the institutions than goes to provide community-based services.
In dollars, $ 12.5 b was spent on MR/DD institutions versus $ 19.3 b spent
for community-based services. While it's still much too much for MR/DD
institutionalization, it's a significantly better balanced than for
persons with disabilities.
For persons with PD/A (regardless of their age), 71.4 % was expended on
nursing facility institutional services and 28.6% on community-based
services. In dollars, nursing homes received $ 47.7 b to institutionalize
persons with PD/A versus $ 19.2 b was spent for community-based services.
In dollar amounts that we can identify with, for people with PD/A, $2.48
was spent on nursing homes for every $1.00 in the community. Compare that
with MR/DD, where "0.65 was spent on the ICF/MR institutions for every
$1.00 spent in the community.
Quite a difference. Why the lopsided distribution based on type of
disability?
Have advocates for persons with PD/A devoted as much effort as advocates
for persons with MR/DD to eliminate the a state's institutional bias?
Are the MR/DD advocates better organized than the PD/A advocates? More
aggressive? Better at the political process?
Do MR/DD advocates have more clout at the State level than PD/A advocates?
Why hasn't there been a public discussion on the lopsided MR/DD versus
PD/A distributions?
Surely, people with MR/DD or with PD/A are equally valuable and important,
and they deserve the same opportunity to reside in the community.
Let's look at the differences in each State. The following chart provides
two columns - the first for MR/DD and the second for PD. For each, we
provide the ratio of expenditures, i.e., the amount of institutional
expenditures for each $1 of community expenditures.
How does your State compare?
Ratio of expenditures for institutional versus community; that is, how
much MA funds were spent in institutions for each MA $1 spent in the
community?
|
MR/DD Institution vs Community |
PD Institution vs Community |
| Alabama |
$0.15 to $1 |
$7.94 to $1 |
| Alaska |
$0 to $1 |
$0.94 to $1 |
| Arizona* |
n/a |
$1.53 to $1 |
| Arkansas |
$1.42 to $ 1 |
$2.84 to $1 |
| California |
$0.53 to $1 |
$1.07 to $1 |
| Colorado |
$0.19 to $1 |
$1.99 to $1 |
| Connecticut |
$0.68 to $1 |
$4.02 to $1 |
| Delaware |
$0.34 to $1 |
$6.63 to$1 |
| D. C. |
$4.51 to 1 |
$2.69 to $1 |
| Florida |
$0.40 to $1 |
$6.88 to $1 |
| Georgia |
$0.46 to $1 |
$5.16 to $1 |
| Hawaii |
$0.10 to $1 |
$4.89 to $1 |
| Idaho |
$1.04 to $1 |
$1.48 to $1 |
| Illinois |
$1.66 to $1 |
$3.88 to $1 |
| Indiana |
$1.50 to $1 |
$11.33 to $1 |
| Iowa |
$1.05 to $1 |
$3.05 to $1 |
| Kansas |
$0.28 to $1 |
$1.79 to $1 |
| Kentucky |
$0.74 to $1 |
$4.18 to $1 |
| Louisiana |
$2.48 to $1 |
$4.75 to $1 |
| Maine |
$0.27 to$1 |
$2.99 to $1 |
| Maryland |
$0.13 to $1 |
$5.05 to $1 |
| Massachusetts |
$0.24 to $1 |
$3.08 to $1 |
| Michigan |
$0.02 to $1 |
$5.27 to $1 |
| Minnesota |
$0.19 to $1 |
$1.33 to $1 |
| Mississippi* |
$253.60 to zero |
$40.50 to $1 |
| Missouri |
$0.74 to $1 |
$2.35 to $1 |
| Montana |
$0.20 to $1 |
$2.47 to $1 |
| Nebraska |
$0.43 to $1 |
$3.93 to $1 |
| Nevada |
$0.44 to $1 |
$2.10 to $1 |
| New Hampshire |
$0.02 to $1 |
$6.47 to $1 |
| New Jersey |
$0.84 to $1 |
$3.87 to $1 |
| New Mexico |
$0.11 to $1 |
$0.86 to $1 |
| New York |
$0.74 to $1 |
$1.77 to $1 |
| North Carolina |
$1.30 to $1 |
$1.32 to $1 |
| North Dakota |
$1 to $1 |
$16.60 to $1 |
| Ohio |
$1.11 to |
$3.74 to $1 |
| Oklahoma |
$0.51 to $1 |
$2.75 to $1 |
| Oregon |
$0 to $1 |
$.82 to $1 |
| Pennsylvania |
$0.48 to $1 |
$7.31 to $1 |
| Rhode Island |
$0.04 to $1 |
$7.60 to $1 |
| South Carolina |
$0.84 to $1 |
$3.99 to $1 |
| South Dakota |
$0.27 to $1 |
$8.51 to $1 |
| Tennessee |
$0.66 to $1 |
$87.31 to $1 |
| Texas |
$1.69 to $1 |
$1.19 to $1 |
| Utah |
$0.50 to $1 |
$9.16 to $1 |
| Vermont |
n/a |
$2.68 to $1 |
| Virginia |
$0.74 to $1 |
$3.34 to $1 |
| Washington |
$0.33 to $1 |
$0.87 to $1 |
| West Virginia |
$0.30 to $1 |
$3.50 to $1 |
| Wisconsin |
$0.35 to $1 |
$2.30 to $1 |
| Wyoming |
$0.22 to $1 |
$4.03 to $1 |
|
|
|
| National |
$0.65 to $1 |
$ to $1 |
This data was computed from the CMS' MA reports from each state based on
actual expenditures. The data is compiled by Thompson/Medstat, to whom we
are very appreciative.
|