1

CHOICES FOR CARE

Blazing the Trail to

Real Choices

Joan K. Senecal, CommissionerVermont Department of Disabilities, Aging and Independent Living

joan.senecal@ahs.state.vt.us

June 6, 2008Long Term Care Financing and Coverage Reform

2

Overview

Orientation to the Choices for Care Waiver

Implementation

Important Elements

How are we doing?

3

Overview – Choices for Care

A 5-year 1115 Demonstration Waiver Global Budget (nursing homes and home and

community based services) 5-year budget is capped, but allows for an

average 7.28% increase/year. Settings

Nursing Homes Home-Based Services Enhanced Residential Care

4

Choices for Care Goals

Provide equal access to various settings for long-term care services and supports

Serve more people

Create a balanced system of long-term care by increasing the capacity of the home and community-based system, and maintaining the optimum number of quality nursing home beds

Manage the costs of long-term care

Prepare for future population growth

5

CHOICES FOR CARE ELIGIBILITY

Highest Need

Moderate Need Group

High

Low

Ac

uit

y o

f N

eed

Level of Care for Eligibility

Entitlement Groups

High Need Group

6

SETTINGS AND SERVICES

Nursing Homes Enhanced Residential Care Home-Based Care and Supports

Case Management Personal Care Adult Day Respite Companionship Home Modifications/Assistive Technology Emergency Response System

7

Home-Based Care Options

Agency Directed Consumer/Surrogate Directed Flexible Choices Programs for All-inclusive Care for the Elderly

(PACE) 24-hour Option Spousal payment as caregivers

8

Providers

Adult Day Providers (14) Area Agencies on Aging (5) Enhanced Residential Care Homes (49) Home Health Agencies (12) Nursing Homes (39) VT-PACE Inc. (2 sites) New: Developmental Services Providers &

Traumatic Brain Injury Providers (limited)

9

Quick Overview

Choices for Care offers equal choice among all long-term settings – nursing home, home-based services, and enhanced residential care.

Applicant’s needs are based on a clinical assessment and determined to be Highest, High, or Moderate Need; individuals must also meet financial eligibility criteria.

Highest Needs individuals are entitled to services and enrolled as soon as Medicaid financial eligibility has been determined.

High Needs individuals are entitled; however are enrolled when funds are available. Wait list opened 2/1/08 - 31 people.

Moderate Needs services are preventative in nature. Include adult day, homemaker and case management. Enrollment is limited by the available funds.

10

Choices for Care

At the

Local Level

11

Getting Started

Work in the Communities - Local Structure 14 Long Term Care Clinical Coordinators

(LTCCCs) – State employees Co-located with Long Term Care Financial

Eligibility Specialists in 12 district offices (VT does not have county government)

12

Getting Started

Local Choices for Care (CFC) Teams meet monthly Members: LTC Eligibility Specialists, local case

managers, CFC providers, hospital discharge planners, LTC Ombudsman

LTCCC facilitates meetings Status of CFC applicants discussed Brainstorming on other available

resources/services

13

Role of the LTCCC

Receives CFC applications

Contacts applicant within 3 working days to schedule clinical eligibility assessment

Completes face-to-face LTC clinical eligibility assessment wherever the applicant is currently located; home, hospital, nursing facility, or residential care home Clinical assessment addresses health, functional

and cognitive status of the client.

14

Role of the LTCCC (cont’d) If possible, provides an immediate answer about

clinical eligibility.

Provides Options Education: information about CFC services, choice of settings and information about other available community services and resources

Explains choice of Case Management organizations and notifies selected agency about client’s choice and eligibility status

Advises applicant/family to immediately apply for LTC Medicaid Financial eligibility

15

Participants have equal access to the long term care settings of their choice. Participants may move from one setting to another.

Applicants have a face to face meeting for the LTC clinical eligibility assessment and learn about their long term care options.

Formation of strong teams and partnerships to help ensure the participant is receiving necessary services in the setting of their choice.

Important elements

16

Vermont Public Expenditures for Long Term CareFY 1999 - FY 2008 est

* Home & Community-Based Services include CFC, AAA State funds, Adult Day,Alzh/Dementia grants, Commodity Food, Supportive Housing, Flex Funds, ASP,TBI Waiver, Home Modification, Homemaker, Mental Health & Aging, and other.Excludes DS Waiver, High Tech, and Children's Personal Care Services.

FY 1999

18%

82%

Home &Community-Based

Services*

Nursing Homes

FY 2008 est

62%

38%Home &

Community-Based Services*

Nursing Homes

17

18

Financial Monitoring – FY 2008

08 Planned Amount July-Sept 07 Oct-Dec 07 Jan-Mar 08 April-May 08 Average/Total

Average number HCB persons 1st of the month 2,370 2,376 2,383 2,392 2,380 Nursing Home Days 182,517 180,534 180,534 182,517 726,102

Home and Community Based Expenses 12,508,291$ 12,939,150$ 12,946,046$ 12,964,868$ 51,358,355$ Nursing Home Expenses 28,143,825$ 27,837,913$ 27,837,913$ 28,143,825$ 111,963,476$ Acute Care Expenses 6,061,726$ 6,080,357$ 6,081,385$ 6,129,807$ 24,353,276$ 187,675,107$

Actual Average number persons 1st of the month 2,409 - - - 2,409 Nursing Home Days 58,816 - - - 58,816

HB Expenses 3,347,538$ -$ -$ -$ 836,884$ Acute Care Expenses 1,703,033$ -$ -$ -$ 425,758$

Difference from Planned Amount (reflects 1 month of data only) Average number persons 1st of the month (39) Nursing Home Days 123,701

Home and Community Based Expenses 9,160,754$ Acute Care Expenses 26,440,792$

Note: Only July '07 expenditure data are shown on this sheet