WASHINGTON, June 17 (UPI) -- Vermont's Medicaid program this fall will offer its indigent, elderly and disabled beneficiaries more choices in deciding between nursing home and home-based care.
The new Vermont Long Term Care Plan, approved this week by the Department of Health and Human Services, is one example of how using state Medicaid waivers accomplishes a goal for the Bush administration and gives seniors what they want.
"Most people we find prefer to be in their own homes instead of a nursing home when they can," said Mary Kahn, spokeswoman for the Centers for Medicare & Medicaid Services.
Medicaid, a $300 billion-plus per year program operated jointly by the states and federal government, is the largest purchaser of nursing-home care in the United States, paying for almost half of all nursing-home care provided. The federal government and the states believe money can be saved through home-based care, an important consideration as the 76 million baby boomers head into retirement -- many without enough savings to cover their long-term healthcare needs.
Vermont's Medicaid program already has provisions that poor seniors who qualify for the program are entitled to nursing-home care but are not guaranteed at-home care, Patrick Flood, commissioner of the state's Department of Aging and Independent Living, told United Press International. Home-based services are also under-funded, he added.
The new plan will give beneficiaries equal access to traditional nursing home and home-based care and will add about $2.8 million each year to provide 100 additional people with the ability to receive care at home.
"This is a completely consumer-based approach," said Flood, who will head the five-year demonstration scheduled to begin Sept. 1.
Flood predicted that as people realize they have options for long-term care, many will chose to remain at home over going to nursing homes or other assisted-living facilities.
Mary Guthrie, acting director of the Center for Planning and Policy Development at the U.S. Administration on Aging, said a bias toward institutionalized care exists in Medicaid programs because that is where the funding has been focused, and people are not informed of other long-term care options.
Data from the senior advocacy group AARP shows in 2003 about 67 percent of the long-term dollars in the Medicaid budget was spent on institutionalized care, and 33 percent on home and community-based services.
"What we're trying to do is reverse the trend and say if you have resources available to stay in the community, will you in fact stay in the community," she said. "Think of alternatives to relying on the formal system."
The Vermont plan is an example of "rebalancing" -- a national effort to shift the emphasis from institutional long-term care to care that can be provided in the home, Kahn said.
Many states now use Home and Community-Based Service waivers as part of their Medicaid plans to provide home services -- ranging from physical and occupational therapists to attendants that help patients with cleaning and cooking. Vermont's plan is different, however, because it will use a tiered system to evaluate each person's level of need, Kahn said.
"They're basically deciding Mrs. Smith is at a certain level of need and therefore the appropriate placement for her is X or Y," Kahn said.
Each beneficiary will be assessed based on the eligibility criteria, and those who fall into the highest tier of need will receive the choice between home-based or traditional care. Though the concept of a screening process is not new, the entitlement to a choice of care is.
"If you're a very high-needs person, you're not going on a waiting list, you've got an entitlement that you've never had before," Flood said.
Between 85 percent and 95 percent of people currently eligible for nursing homes in Vermont will become part of the new entitlement group, Flood said. The remaining people still will be eligible for services based on the remaining budget.
"We fully believe we're going to have enough money to do all that and serve more people," Flood said.
In Vermont, the average cost for a Medicaid beneficiary in a nursing home is $54,000 annually, slightly lower than the national average of $60,000. The cost for home-based care in Vermont is estimated at $28,000 per person, Flood said.
"Even when you add in things like prescription drugs and hospital costs, which are not part of the waiver, it is still two-thirds of the cost of being in a nursing home," he added.
Dolly Fleming, executive director of the advocacy Community of Vermont Elders, supports the concept but said she is working with the state to ensure regulations are followed and the cost of home-based care is not underestimated.
"We really strongly support the full spectrum of services and are under no illusion that it means there should be no nursing homes," Fleming told UPI.
Vermont's plan was approved under a Section 1115 Medicaid waiver, which allows the state to adjust coverage to include elderly and disabled citizens who would not otherwise qualify for the Medicaid program.
Vermont's plan would be applicable to any state, Flood said. By giving people equal access to services, "more people will stay at home, we'll save money, and that will permit us to serve even more people than we otherwise could," he said. "That's a very simple concept that could really work anywhere."