Olmstead

Statistics show a significant percentage increase in older persons able to receive LTSS outside of nursing homes, however unnecessary institutionalization is still a routine problem. This report clearly delineates the limitations on progress, including differences in Medicaid structure around nursing home vs. HCBS waiver coverage. The authors recommend specific steps that federal and state governments should take to reduce unnecessary institutionalization.

This report is the latest in a series of annual reports on Medicaid long-term care expenditures. Table 1 presents national expenditures data for FY 1997–FY 2009. Tables A through T present state-by-state expenditures data for FY 2004–FY 2009 for specific categories of service. Tables U, V, and W present the distribution of each state’s LTC expenditures among institutional and community-based services.

The authors of this report conclude that in the 10 years since the Olmstead decision, there has been little national (though some individual state) progress moving people with disabilities out of nursing facilities and public institutions and into communities with supports. The report includes an overview of Olmstead, institutional data, and recommendations for improvement.

This letter was issued to provide information on new tools for community integration and to remind States of existing tools that remain strong resources in their efforts to support community living. Various technical assistance resources are listed, including a new guide for enhancing the availability of HCBS within managed care delivery systems. Progress around the HUD partnership, HCBS waiver and state plan options, grant programs, ADRCs and discharge planning are discussed as well.

This report presents Medicaid long-term care expenditures data in Federal Fiscal Year 2008 (Oct 2007 - Sept 2008). Table 1 shows national data from 1996 - 2008. Other tables present state-by-state data for nursing homes, ICF/MR, state plan personal care, state plan home health, 1915(c) waivers, 1115 waivers that provide HCBS, and other Medicaid services.

The Bazelon Center for Mental Health Law issues this call to action to inform advocates, policymakers and the public about the vital role the Supreme Court’s landmark decision plays in enabling people with mental illnesses to benefit from community life. The Olmstead decision is now 10 years old. According to the report, many people with mental illnesses remain segregated in board-and-care homes, nursing facilities and other institutions even though supportive community living is cost-effective.

Three researchers use data from the Survey of Income and Program Participation to estimate the expense of a mandatory personal assistance services (PAS) benefit under Medicaid for persons with low incomes, low assets, and significant disability. They conclude that the cost would be much lower than estimated by the Congressional Budget Office. They also argue that this step would help eliminate the institutional bias of Medicaid.

The question posed in the title is answered by analyzing state spending data from 1995-2005. The report shows that, for two distinct populations receiving long-term care services, spending growth was greater for states offering limited noninstitutional services than for states with large, well-established noninstitutional programs. Expansion of HCBS appears to entail a short-term increase in spending, followed by a reduction in institutional spending and long-term cost savings.

Tables listing the formal strategies adopted by each state to achieve compliance with the Olmstead decision and community integration lawsuits related to the case are maintained here. In 1999, the Supreme Court found that people have the right to receive care in the most integrated, least restrictive setting appropriate. This report gives more details on that decision and summarizes the impact it has had on community integration in general.

The author focuses on Medicaid and Medicare in offering healthcare reform suggestions. Both legislative and administrative actions are proposed regarding eligibility and enrollment, access to services, program management and delivery systems issues, and financing. Several options relate to HCBS, such as protecting spouses of the medically needy, expanding eligibility for SSI-related groups, and issuing further guidance on waiver waiting lists.