[LTPC-discussions] Fw: LTC Bullet: Medicaid Waivers Waver on Quality
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Sat, 2 Aug 2003 09:56:47 -0600
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From: "Center for Long-Term Care Financing" <ltcbullets@centerltc.org>
To: <Recipient list suppressed>
Sent: Thursday, July 17, 2003 12:14 PM
Subject: LTC Bullet: Medicaid Waivers Waver on Quality
> LTC Bullet: Medicaid Waivers Waver on Quality
>
> Thursday, July 17, 2003
>
> Seattle--
>
> LTC Comment: Federal and state Medicaid officials pushed hard to divert
> recipients from nursing homes to home and community-based services. But
> problems abound. Now add laxity on quality to the issues we've raised
> before, including the woodwork factor, increased Medicaid planning, and
> decreased LTC insurance. More after the ***news.***
>
> *** WINSTON CHURCHILL said: "You can always count on Americans to do the
> right thing -- after they've tried everything else." Are we getting close
> to doing the right thing in long-term care? It sure seems like we've
tried
> everything else. We've tapped out Medicaid. That program can no longer
> guarantee access to quality care for the poor, much less the middle class,
> in nursing homes, much less in home and community-based care. Yet private
> LTC insurance has not filled the void. Sales and profits have
disappointed
> numerous carriers, wholesalers, and producers, leading many to consolidate
> or exit the market altogether. Now comes word that Citizens for Long-Term
> Care, a coalition of LTC stakeholders seeking a public/private partnership
> for LTC, has disbanded. Other rumors indicate that the Robert Wood
Johnson
> Foundation is "pausing" in its support of long-term care
> research. HELLO! Can't we see the connection here? Excessive
utilization
> of Medicaid LTC benefits by the middle class is overwhelming Medicaid.
But
> too few people buy private LTC insurance because of the "entitlement
> mentality" created by 38 years of government-financed long-term care.
Most
> people don't realize the consequences of ignoring the risk of long-term
> care until they're too sick or too old to qualify (medically or
> financially) for private insurance. The good news is that the solution is
> simple. Give Medicaid back to the poor and use the savings to fund strong
> tax incentives for private financing of long-term care through home equity
> conversion and LTC insurance. For more on this approach to the problem,
> visit http://www.centerltc.org/ . ***
>
> *** Your tax-deductible contribution to the Center for Long-Term Care
> Financing does much more than gain access to our popular donor-only
> publications and website Zone. It helps support our fight for rational
> long-term care policy. The Center's mission is to ensure quality
long-term
> care for all Americans. We pursue that mission by advocating public
policy
> to target Medicaid to the genuinely needy and to encourage everyone who is
> young, healthy and affluent enough to plan early and save, invest or
insure
> for long-term care. You can support the Center for Long-Term Care
> Financing by sending a check (at least $150 annually for donor zone access
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>
> LTC BULLET: MEDICAID WAIVERS WAVER ON QUALITY
>
> Resolved: Medicaid should cover and pay adequately for the full range of
> long-term care services--home care, adult day care, respite care, assisted
> living, and nursing home care among others.
>
> Who would disagree? Not us. But here's the problem. Medicaid's generous
> LTC eligibility rules allow people with substantial income (any amount
> under the cost of nursing home care) and assets (any amount as long as
> they're held in exempt form such as a home, business, auto, "inaccessible
> assets," etc.) to qualify. Consequently, the program cannot afford to pay
> adequately for nursing home care, much less for home and community-based
> services, which, because they are more attractive than institutional care,
> draw extra claimants out of the "woodwork," increase demand for Medicaid
> estate planning, and impede the market for private LTC insurance.
>
> Despite the difficulty of funding HCBS adequately without controlling the
> hemorrhage in Medicaid eligibility, the courts, politicians and Medicaid
> administrators have pushed hard for expanded HCBS through federal waivers
> and looser controls on state plan amendments. For details on the Bush
> Administration's multi-million dollar "New Freedom" initiative to
encourage
> HCBS, go to http://cms.hhs.gov/newfreedom/ . We've written about these
> issues in previous LTC Bullets because the more attractive Medicaid
becomes
> without targeting it to the genuinely needy, the less chance we have to
> encourage personal responsibility for and private financing of long-term
> care. Here are links to earlier Bullets on the subject: "LTC
> Bullet: Will Olmstead Help or Hurt Long-Term Care?," August 3,
> 2000, http://www.centerltc.com/bullets/archives2000/olmstead.htm and "LTC
> Bullet: Olmstead Languishes," April 8, 2002,
> http://www.centerltc.com/bullets/archives2002/354.htm .
>
> Well, the chickens are really coming home to roost now. The problems we
> predicted in the Bullets cited above are worsening. The General
Accounting
> Office (GAO) has found that Medicaid did not provide adequately for
quality
> control as part of the program's heavy push toward home and
community-based
> services. Following is a link to and a summary of GAO's report, plus
links
> to a story and an editorial on the subject in the New York Times. If we
> are to have any hope of saving Medicaid as a long-term care safety net for
> the uninsurable, policymakers will have to target the program's benefits
to
> a smaller number of genuinely needy recipients and provide strong positive
> incentives for healthy, prosperous people to plan early and save or insure
> for long-term care. To read our plan for that solution, see "LTC
> Choice: A Simple, Cost-Free Solution to the Long-Term Care Financing
> Puzzle" at http://www.centerltc.com/pubs/CLTCFReport.pdf .
>
> General Accounting Office, "LONG-TERM CARE: Federal Oversight of Growing
> Medicaid Home and Community-Based Waivers Should Be Strengthened,"
> Washington, D.C., GAO-03-576, June 2003,
> http://www.gao.gov/cgi-bin/getrpt?GAO-03-576 .
>
> Summary:
>
> "Feds Lax on Medicaid Waiver Quality Assurance, GAO Says. WASHINGTON, DC
> -- 07/08/2003 -- (Eli Digital) The federal government needs to do a
> better job of monitoring the quality of care being provided to elderly
> Americans through Medicaid waiver programs, which the Bush administration
> is promoting as an alternative to nursing homes. That's the conclusion of
> a new General Accounting Office report titled 'Federal Oversight of
Growing
> Medicaid Home- and Community-Based Waivers Should Be Strengthened'
> (GAO-03-576). Requested by Sens. Charles Grassley (R-IA) and John Breaux
> (D-LA), the study examined waivers that allow states to cover home- and
> community-based care for elderly Medicaid beneficiaries. The GAO found
one
> or more quality of care problems in 70 percent of the waivers for the
> elderly it reviewed. The most common problems were failure to provide
> necessary services, weaknesses in plans of care and poor case
> management. The report charged the Centers for Medicare & Medicaid
> Services with failing to adequately monitor state waivers and the quality
> of beneficiary care. . . ."
>
> Source: LTC Daily Analysis Briefs, July 8, 2003, prepared by
> http://www.eliresearch.com/ for http://www.snalfnews.com/,
> http://www.snalfnews.com/AnalystNews.cfm?id=2340 .
>
> For the NYT story on the GAO report, see: Robert Pear, "Report Criticizes
> Federal Oversight of State Medicaid, New York Times, July 7, 2003,
>
http://www.nytimes.com/2003/07/07/politics/07MEDI.html?hp=&pagewanted=print&
position=
> . The NYT charges $2.95 each for complete copies of this archived article
> and the editorial which follows.
>
> Excerpt:
>
> "The Bush administration has allowed states to make vast changes in
> Medicaid but has not held them accountable for the quality of care they
> provide to poor elderly and disabled people, Congressional investigators
> said today.
>
> "The administration often boasts that it has approved record numbers of
> Medicaid waivers, which exempt states from some federal regulations and
> give them broad discretion to decide who gets what services.
>
> "But the investigators, from the General Accounting Office, said the
> secretary of health and human services, Tommy G. Thompson, had 'not fully
> complied with the statutory and regulatory requirements' to monitor the
> quality of care under such waivers.
>
> "The accounting office examined 15 of the largest waivers, covering
> services to 266,700 elderly people in 15 states and found problems with
the
> quality of care in 11 of the programs. In many cases, Medicaid
> beneficiaries simply did not receive the services they were supposed to
> receive. . . ."
>
> For the NYT editorial, titled "Is Home Care Really Working?," published
> July 8, 2003, go to
>
http://www.nytimes.com/2003/07/08/opinion/08TUE1.html?pagewanted=print&posit
ion=
>
>
> Excerpt:
>
> "The idea sounds great in principle. Instead of confining elderly
Medicaid
> patients in nursing homes when they become infirm, why not give them a
> broad array of options, everything from home care to adult day care
centers
> and assisted living? That would please many of the elderly, who prefer to
> stay at home near friends and family as long as possible. It would also
> please state and federal Medicaid administrators, whose budgets are
swamped
> with the high cost of nursing home care for elderly patients. No wonder
> the Bush administration has encouraged states to experiment with home- or
> community-based care under so-called Medicaid waivers, and no wonder many
> governors have responded enthusiastically. The trouble is, in many cases
> no one seems to be monitoring the quality of the care provided, or even
> whether it is provided at all. . . . The lack of oversight raises the
> frightening possibility that the nation could be headed into another
social
> experiment that starts with great promise and ends with human disasters. .
> . ."
>
> A formatted version of today's LTC Bullet is available at
> http://www.centerltc.org/bullets/current/453.htm .
>
>
>
> _____________
>
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>
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