FY 2006: Medicaid Expenditures for Institutions versus Community-Based Services.
Medicaid data for FY 2006 provides extremely helpful information to analyze and
compare how your State distributes and allocates its Medicaid Long Term Care
expenditures between its institutional versus community-based services.
Nationally, for all disabilities, 60.6 % of MA's long term care expenditures
went to institutions, i.e, both to nursing homes (for disabled persons of all
ages, "PD/A," physical disabilities/aged) and to intermediate care facilities
(for persons with "MR/DD," mental retardation/ development disabilities). In
contrast, 39.4% of all MA's long term care expenditures went for community
services, i.e., for waivers (i.e., both PD/A and MR/DD), personal care option,
and home health services in the community.
To understand the balance or ratio, think of a scale, with nursing homes and ICF
MR/DD on the side, representing institutional expenditures, and, on the other
side of the scale, with waivers, personal care and home health services,
representing the community-side expenditures.
To have a clearer or more accurate picture of the scale, it's necessary to break
down and compare specific institutions with specific community services.
When disabilities are broken down by MR/DD and PD/A, a dramatic difference
exists in the 60.6 % national long term care distribution.
For persons receiving MR/DD services, nationally only 39.3% went for
institutions (ICF-MRs) and 60.7% was spent for community-based services. That's
correct: less Medicaid funds go to institutionalize persons with MR/DD in the
institutions than goes to provide community-based services.
In dollars, $ 12.5 b was spent on MR/DD institutions versus $ 19.3 b spent for
community-based services. While it's still much too much for MR/DD
institutionalization, it's a significantly better balanced than for persons with
disabilities.
For persons with PD/A (regardless of their age), 71.4 % was expended on nursing
facility institutional services and 28.6% on community-based services. In
dollars, nursing homes received $ 47.7 b to institutionalize persons with PD/A
versus $ 19.2 b was spent for community-based services.
In dollar amounts that we can identify with, for people with PD/A, $2.48 was
spent on nursing homes for every $1.00 in the community. Compare that with MR/DD,
where "0.65 was spent on the ICF/MR institutions for every $1.00 spent in the
community.
Quite a difference. Why the lopsided distribution based on type of disability?
Have advocates for persons with PD/A devoted as much effort as advocates for
persons with MR/DD to eliminate the a state's institutional bias?
Are the MR/DD advocates better organized than the PD/A advocates? More
aggressive? Better at the political process?
Do MR/DD advocates have more clout at the State level than PD/A advocates?
Why hasn't there been a public discussion on the lopsided MR/DD versus PD/A
distributions?
Surely, people with MR/DD or with PD/A are equally valuable and important, and
they deserve the same opportunity to reside in the community.
Let's look at the differences in each State. The following chart provides two
columns - the first for MR/DD and the second for PD. For each, we provide the
ratio of expenditures, i.e., the amount of institutional expenditures for each
$1 of community expenditures.
How does your State compare?
Ratio of expenditures for institutional versus community; that is, how much MA
funds were spent in institutions for each MA $1 spent in the community?
MR/DD PD
Institution vs Community Institution vs Community
Alabama "0.15 to $1 $7.94 to $1
Alaska $0 to $1 "0.94 to $1
Arizona* n/a $1.53 to $1
Arkansas $1.42 to $ 1 $2.84 to $1
California "0.53 to $1 $1.07 to $1
Colorado "0.19 to $1 $1.99 to $1
Connecticut "0.68 to $1 $4.02 to $1
Delaware "0.34 to $1 $6.63 to$1
D. C. $4.51 to 1 $2.69 to $1
Florida "0.40 to $1 $6.88 to $1
Georgia "0.46 to $1 $5.16 to $1
Hawaii "0.10 to $1 $4.89 to $1
Idaho $1.04 to $1 $1.48 to $1
Illinois $1.66 to $1 $3.88 to $1
Indiana $1.50 to $1 $11.33 to $1
Iowa $1.05 to $1 $3.05 to $1
Kansas "0.28 to $1 $1.79 to $1
Kentucky "0.74 to $1 $4.18 to $1
Louisiana $2.48 to $1 $4.75 to $1
Maine "0.27 to$1 $2.99 to $1
Maryland "0.13 to $1 $5.05 to $1
Massachus "0.24 to $1 $3.08 to $1
Michigan "0.02 to $1 $5.27 to $1
Minnesota "0.19 to $1 $1.33 to $1
Mississippi* $253.60 to zero $40.50 to $1
Missouri "0.74 to $1 $2.35 to $1
Montana "0.20 to $1 $2.47 to $1
Nebraska "0.43 to $1 $3.93 to $1
Nevada "0.44 to $1 $2.10 to $1
New Hampshire "0.02 to $1 $6.47 to $1
New Jersey "0.84 to $1 $3.87 to $1
New Mexico "0.11 to $1 "0.86 to $1
New York "0.74 to $1 $1.77 to $1
North Carolina $1.30 to $1 $1.32 to $1
North Dakota $1 to $1 $16.60 to $1
Ohio $1.11 to $3.74 to $1
Oklahoma "0.51 to $1 $2.75 to $1
Oregon "0 to $1 ".82 to $1
Pennsylvania "0.48 to $1 $7.31 to $1
Rhode Island "0.04 to $1 $7.60 to $1
South Carolina "0.84 to $1 $3.99 to $1
South Dakota "0.27 to $1 $8.51 to $1
Tennessee "0.66 to $1 $87.31 to $1
Texas $1.69 to $1 $1.19 to $1
Utah "0.50 to $1 $9.16 to $1
Vermont n/ $2.68 to $1
Virginia "0.74 to $1 $3.34 to $1
Washington "0.33 to $1 "0.87 to $1
West Virginia "0.30 to $1 $3.50 to $1
Wisconsin "0.35 to $1 $2.30 to $1
Wyoming "0.22 to $1 $4.03 to $1
National "0.65 to $1 $ to $1
* Complete data is apparently available.
This data was computed from the CMS' MA reports from each state based on
actual expenditures. The data is compiled by Thompson/Medstat, to whom we
are very appreciative.
Steve Gold, The Disability Odyssey continues
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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
