>>SLIDE 1 SILC-NET Presents… Federal Opportunities to Expand Community Living in Your State: A National Teleconference & Webcast Thursday, August 6, 2009; 3:00 PM – 4:30 PM EDT >>SLIDE 2 Today’s Discussion -Update on Money Follows the Person -Administration on Aging Community Living Program -Veterans Administration – Home and Community-Based Services Program >>SLIDE 3 Money Follows the Person -Major initiative under Deficit Reduction Act of 2005 (DRA) -Intent – Move Medicaid enrolled individuals from institutions to community -Authorized $1.7 billion in grants to states -Selected 31 states in 2007 (AR, CA, CN, DC, DE, GA, HI, IA, Il, IN, KA, KE, LA, MD, MI, MS, NC, ND, NE, NH, NJ, NY, OH, OK, OR, PA, SC, TX, VA, WA and WI) -Program will last 5 years 2007 – 2011 -Report to Congress 2012 >>SLIDE 4 What Do We Hope to Gain? -What services are necessary to successfully transition? -Do individuals living in the community have better health outcomes? -Does community living save money? -What tasks/activities are needed to successfully transition? -Do we have enough positive information to change the law? >>SLIDE 5 The Shift is Happening Graph: Growth in Medicaid Long-Term Care Expeditures, 1990-2006 1990 = $32 billion (community-based services = 13%; Institutional Care = 87%) 1995 = $54 billion (community-based services = 20%; Institutional Care = 80%) 2000 = $75 billion (community-based services = 30%; Institutional Care = 70%) 2002 = $92 billion (community-based services = 32; Institutional Care = 68%) 2004 = $100 billion (community-based services = 37%; Institutional Care = 63%) 2006 = $109 billion (community-based services = 41%; Institutional Care = 59%) Source: Kaiser Commission on Medicaid and the uninsured and Urban Institute >>SLIDE 6 Who Will Transition? -Originally 38,000; Revised down 34,000 -Ranges: high in IL of 3,357 to low 100 in DE -Breakdown: --605+ (48%) --Younger Persons with Disabilities (26.3%) --Individuals with Intellectual or Developmental Disabilities (19.3%) --Individuals with Mental Illness (3.8%) --Dually Diagnosed (3.1%) >>SLIDE 7 Congressional Expectations Congress will have reliable data on transitioning experience for first time -Change Social Security Act -Rebalance state budgets Strong emphasis on self direction and consumer participation >>SLIDE 8 Congressional Expectations Mathematica will evaluate: -Goals met -System rebalanced -Program implemented as intended -Understand cost impact Redefine Home Setting: -Must have control over coming and going -No locked doors -Access to community 24/7 -No congregate eating -May include no more than 4 individuals -Excludes assisted living >>SLIDE 9 Early Lessons Learned -States with previous experiences are farther along -Housing is major challenge --Dedicated Housing Specialist --Communication with Public Housing Authorities --Use of Web-based Housing Register --Develop Housing Task Force >>SLIDE 10 Early Lessons Learned -Enrollment Slow – 1,505 (12/08) Should be 4,250 --State Economic Conditions - Budget Crisis ---Hiring Freezes -Targeting Criteria Lack of consistent and enthusiastic state leadership -Wait lists for waiver slots -Resistance by provider community-facilities & institutions -Enacting law to guarantee advocates have access to residents >>SLIDE 11 Questions & Answers >>SLIDE 12 Administration on Aging -Deficit Reduction Act of 2005 – Positioned Administration on Aging -In 2007 Administration on Aging awarded 12 states diversion grants of $500,000 each ($8.8 Million) -In 2008 new grantees added 14 additional states ($16.2 Million) -In 2009 – 30 letters of intent – Due August 3, 2009 >>SLIDE 13 Community Living Program -Congress: modernize & transform current system -Use Older Americans Act and other Non-Medicaid Funding -Create flexible, self-directed service dollars -Complements the Money Follows the Person Initiative -Supports state long-term service rebalancing efforts >>SLIDE 14 Hoping to Achieve -Flexible dollars to ensure services can be tailored to individualized needs of consumers and family caregivers, rather than tied to particular service/set of services -Criteria to target individuals to ensure program actually serves those who are most at risk of nursing home placement and spend down to Medicaid -Offering options to provide full choice and control of received services -Strategies that complement and support rather than supplant on-going efforts of family members >>SLIDE 15 Connecting the Dots -Persons with disabilities are growing older -Caregiver Support – often with disabilities -Opportunities for community-based growth -Need for training on the Independent Living Movement >>SLIDE 16 Questions & Answers >>SLIDE 17 Veterans Administration (VA) -2008: Federal Collaboration to develop Home and Community-Based Services for Vets -Partners include Aging Network - consisting of State Units on Aging (SUAs) and Area Agencies on Aging (AAAs) -Serves Vets of all ages at risk of nursing home placement -VA will deliver Veterans-Directed Home and Community-Based Service Program (VDHCBS) in 10 states and invest approximately $3 million to serve veterans at risk of institutionalization -VA will directly purchase services through SUAs and/or AAAs for VDHCBS program >>SLIDE 18 What Type of Services? -Cash and Counseling program -Service Offering: --Personal Care: physical/verbal assistance with eating, bathing, dressing, grooming or transferring --Homemaker: cleaning/laundry/meal plan, prep, & shop --Adult day care --Assistive technology >>SLIDE 19 What Type of Services? (cont.) -Home delivered meals -Caregiver support -Respite -Environmental: yard care, snow removal, extensive cleaning -Other services needed to remain safely in home/community >>SLIDE 20 Referrals -ADRCs, AAAs, SUAs, or other entities may refer potential veterans who are eligible to local VA Medical Center -Each participating VA Medical Center will establish protocol for determining eligibility >>SLIDE 21 Implications for You -New Population Group for AAAs -Training on Independent Living Movement -Case Management Opportunities -Networking -Others? >>SLIDE 22 Questions & Answers >>SLIDE 23 Resources suzanne.crisp.1@bc.edu -www.hcbs.org/moreInfo.php/doc/2655 -www.aoa.gov -http://www.hcbs.org/moreInfo.php/topic/202/doc/2640/Veterans-Directed_Home_and_Community_Based_Service