Change is Happening: Another Look at FY 2005 MA Expenditures. 

By Steve Gold

Information Bulleting # 117 (7/06) 

Disability advocates often are so busy with the daily struggles and obligations that we don't step back to see the bigger picture. Thanks to the Johnson/Medstat compilation of each State's Medicaid expenditures (all data can be found at www.hcbs.org), we can take a look at the data and see the results of your daily struggles to "Free Our People." As slow and tedious as it often feels, YES, SIGNIFICANT PROGRESS has been made. In FY 1993, 84% of the total Medicaid national Long Term Care (LTC) expenditures ($35.4b) went to institutions (i.e., nursing facilities and ICF-MRs) and only 16% went to community-based services (i.e., Medicaid waivers, home health care, and personal care options) ($6.7b). 

Two years later, in FY 1995, there was virtually no percentage change: 84% of the total national LTC expenditures still went to institutions (i.e., nursing facilities and ICF-MRs) and 16% went to community-based services (i.e., waivers, home health care, and personal care options). 

However, in FY 1999, a small change occurred: 82% of the total national LTC expenditures ($46b) went to institutions and 18% went to community-based services ($17b). While not much, it still was a change! 

The Olmstead Supreme Court decision was in 1999 and took a few years to exert its impact. 

By FY 2005, dramatic change is very clear: 63% of the total national LTC expenditures ($59.34b) went to institutions but 37% went to community-based services ($35.16b). 

The difference -- between 16% in 1993 for community-based services and 37% in 2005 for community-based services -- in dollars is an increase from $6 billion dollars to $33.16 billion!

Another way to look at the change is to look at the ratio of institutional versus community expenditures, that is, how many dollars were spent on institutional care versus community-based. 

In 1993, $5.27 was spent in institutions for each $1.00 spent in the community. By 1999, the ratio was reduced so that $2.70 was spent in institutions for each $1.00 in the community. 

By FY 2005, the ratios were reduced to $1.69 expended in institutions for each $1.00 in the community. It's getting a lot closer! Still not equal but closer. 

We have NO DOUBT: these changes are the direct result of local advocates pressuring their Governors, Legislatures and Medicaid officials to "Free Our People." We have NO DOUBT that these changes would NOT have occurred but for your local actions and efforts. 

Now is not the time to sit back. This is a constant battle. Increase your efforts: "power concedes nothing without a struggle." 

Advocates should look at their own State's Medicaid data and determine how much progress your State has made. By following the money, you can see how well your State compares to the above national data. By analyzing the data, you will be able to hold local officials more accountable. 

Steve Gold, The Disability Odyssey continues . . .