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From Steve Gold http://www.stevegoldada.com
Tennessee spends nearly $150 on nursing homes to every dollar
spent on home and community based services.
Your State: Institutional versus Community expenditures. #76
 Several points are important. First, the institutional side is limited to the total Medicaid expenditures by your State (FY 03) for ONLY nursing home expenditures. (This dollar amount does NOT include ICF/MRs, State Centers, or other institutions.)
Second, the community side provides the Medicaid expenditures for only the three waiver categories that are the counterparts to the nursing homes (e.g., only Aged, Disabled and Physical Disabilities HCBS Medicaid Waivers and NOT MR, TBI, AIDS or other waivers.) We did this because eligibility in the three categories (A, D, and PD) requires the person meet the level of care in the nursing home; that is, to receive these waiver services, the person MUST qualify for nursing home care. Therefore, the comparisons are directly on point.
Third, we also included the Medicaid Personal Care option, if your State provided this service. We included the PC Option because many of the States use this instead of or to supplement the three above waiver categories (even though the persons do not necessarily have to meet the nursing home level of care to receive PC services).
MEDICAID EXPENDITURES FY 2003 - NURSING HOMES VS. HOME AND COMMUNITY BASED WAIVERS (for aged, disabled, and physically disabled). If your state provides Medicaid's Personal Care Option services, we added the amount with a + . If your states does not have a "+" it means you State provides only Medicaid waivers and not the PC Option.
The third column provides the ratio of Medicaid institutional to community expenditures. The Supreme Court in Olmstead talked about an "equitable" distribution between institutional versus community expenditures. We are now more than five years post-Olmstead. How is your State, Governor and disability community doing?
| State |
Total Medicaid
expenditures (FY 03) for ONLY nursing homes compared to
Medicaid expenditures for the three waiver categories. |
Ratio of
Medicaid institutional to community expenditures. |
| Alabama |
$769 m vs. $67 m |
11.5
to 1 ratio; |
| Alaska |
$99 m vs. $54 m+44 m |
1
to 1 ratio; |
| Arkansas |
$540 m vs. $59 m+ $58 |
4.6
to 1 ratio; |
| California |
$2.9 B vs$105 m + $1.4 B |
2
to 1 ratio; |
| Colorado |
$409 m vs $104 m |
4
to 1 ratio; |
| Connecticut |
$998 m vs $88 m |
11
to1 ratio; |
| Delaware |
$153 m vs.$12m |
13
to 1 ratio; |
| D. C. |
$192 m vs $3 m + $11m |
13.7
to 1 ratio; |
| Florida |
$2.1 B v $150 m + 19 m |
12.4
to 1 ratio; |
| Georgia |
$897 m vs $115 m |
7.8
to 1 ratio; |
| Hawaii |
$178 m vs. $30 m |
5.9
to 1 ratio; |
| Idaho |
$125 m vs $51 m +$32 |
1.5
to 1 ratio; |
| Illinois |
$1.5 B vs $174 m |
8.6
to 1 ratio; |
| Indiana |
$765 m vs $27 m |
28
to 1 ratio; |
| Iowa |
$495 m vs. $52 m |
9.5
to 1 ratio; |
| Kansas |
$351m vs $171 m + 17 m |
1.8
to 1 ratio; |
| Kentucky |
$620 m vs.$69 m |
9
to 1 ratio; |
| Louisiana |
$594 m vs $26 m |
23
to 1 ratio; |
| Maine |
$238 m vs $41m + 32 m |
3.3
to 1ratio; |
| Maryland |
$803 m vs.$61 m+ $30 |
8.8
to 1 ratio; |
| Massachus |
$1.5 billion v $12m+328 m |
4.4
to 1 ratio; |
| Michigan |
$1B vs $62 m + $208 |
3.7
to 1 ratio; |
| Minnesota |
$930 m v. $265 m +$164 |
2.2
to 1 ratio; |
| Mississippi |
$504 m vs. $64 m |
7.9
to 1 ratio; |
| Missouri |
$734 m vs.$86 m+208 m |
2.5
to 1 ratio; |
| Montana |
$152 vs. $19 m + $24 |
3.5
to 1 ratio; |
| Nebraska |
$352 m vs $30 m + 10 m |
8.8
to 1 ratio; |
| Nevada |
$111m vs $12 m +$23 |
3.2
to 1 ratio; |
| New
Hampshire |
$206 m vs.$24m + $4 |
7.4
to 1 ratio; |
| New
Jersey |
$2 B vs$103 m + $292 |
5
to 1 ratio; |
| New
Mexico |
$166 m vs$36 m +123 m |
1
to 1 ratio; |
| New York |
$7.1 billion vs35 m+2.2B |
3.2
to 1 ratio; |
| North
Carolina |
$885 m vs $183 m+300m |
1.8
to 1 ratio; |
| North
Dakota |
$173 m vs $5 m |
34.6
to 1 ratio; |
| Ohio |
$2.65 B vs $375 m |
7.1
to 1 ratio; |
| Oklahoma |
$440 vs $71 m + $40m |
4
to 1 ratio; |
| Oregon |
$270 m vs $265 m+ $37m |
0.9
to 1 ratio; |
| Pennsylvania |
$4 Billion vs $237 m |
16.9
to 1 ratio; |
| Rhode
Island |
$266 m vs. $28 m |
9.5
to 1 ratio; |
| South
Carolina |
$419m vs$98 m+1m |
4.2
to 1 ratio; |
| South
Dakota |
$130 m vs$7 m + 2 m |
14.4
to 1 ratio; |
| Tennessee |
$898 vs. $6 m |
149
to 1 ratio; |
| Texas |
$1.8B vs $524 m + $378 |
2
to 1ratio; |
| Utah |
$104 m vs $6 m + 1 m |
14.8
to 1 ratio; |
| Vermont |
$96 m vs. $27 m + $9m |
2.6
to 1 ratio; |
| Virginia |
$619 m vs $ 77 m |
8
to 1 ratio; |
| Washington |
$657 m vs $295m + $227m |
1.2
to 1 ratio; |
| West
Virginia |
$331 m vs. $62 + $21 |
4
to 1 ratio; |
| Wisconsin |
$1.3 B vs $144 m+$119m |
4.9
to 1 ratio; |
| Wyoming |
$57 m vs $7 m |
8
to 1 ratio; |
All data is from the MEDSTAT under contract with CMS.
Data
Link One.
and
Data
Link Two.
Steve Gold, The Disability Odyssey continues
Back issues of other Information Bulletins are available online at http://www.stevegoldada.com
with a searchable Archive at this site divided into different subjects. To contact Steve Gold directly, write to
stevegoldada@cs.com
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