MO Care Options

1
MO Care Options

• Seniors Adults with Disabilities
• accessing
• HCB Long-term Care

2
Framework

• Federal New Freedom Initiative
• CMS Medicaid Reform
• AoA Choices for Independence
• CDC Health for Life
• State
• The Governor Healthy Missouri

3
Missouri a closer look

• Largely Rural State
• 30.6 Rural (2.5 on Farms)
• 55.2 in Urbanized Areas
• 14.2 Urban
• Cultural Diversity
• White 84.9
• Black or African American 11.2
• Other 3.9
• 2000 Census Estimates 16.2 Minority Population

4
Seniors Adults with Disabilities

• 755,400 Population age 65 (13th National)
• 42.6 of age 65 with a disability
• 13.3 of MO Population
• 983,700 Age 60
• 98,600 Age 85 (13th in Nation)
• Adults with Disability
• 18.2 of age 21- 64
• 10.8 Work Disability (age 16-64)

5
MO Care Options

• 1992 Legislative Initiative
• Premise Individuals should have the right to
  make informed choices regarding options when
  facing decisions regarding long-term care
• Goal MO should offer options for the right care
  in the right setting at the right time at the
  right cost to the public

6
Medicaid Population

• An estimated 209,000 Participants access
  Medicaid that are Elderly, Blind or have a
  Disability
• 51,500 (24.6) accessed HCBS in FY06
• 24,380 Participants accessed Facility
  based LTC

7
MCO Success Data

• Participation up 171 since 1992
• NF Participation up 1.3
• Spending up 1,040 since 1992
• NF Spending up 111.5
• Access Array of HCB Options increased
• Additional types of services expand access to
  alternative care
• Cost per participant up 320.65
• NF Cost up 108.64

8
Percent of HCB LTC Participation44.15 (1992) ?
67.89 (2007)
9
Percent of HCBS LTC 7.45 (1992) ? 30.27 (2007)
10
Quality HCB Care for every Missourian

• ? Safe Viable Alternatives to Facility Care
• Least restrictive environment
• Accessible at all times
• Promote Independence and Participation
• Improve Quality of Life
• Accountable, Effective
• Efficient

11
Home Community Based Services (HCBS)

• Eligible or Potentially Eligible for Medicaid
  funded Long-term Care
• Family Support Division determines Medicaid
  eligibility
• DSDS Staff determine Level of Care
• State Staff control access to the Medicaid Budget
• Determined to have Unmet Personal Care Needs
• State Staff conduct functional assessment and
  determine level of independent support system

12
Medicaid Funded Long-Term Care

• Cost of Care capped at average statewide cost of
  Facility Care
• State Plan HCBS
• Personal Care
• Care of the Person
• Medically-related Household Tasks
• Nurse Visits
• Adult Day Health Care
• PACE

13
Medicaid Waiver Services

• Aged Disabled Waiver (Age 63 up)
• Homemaker
• Respite
• Adult Day Care
• Home-Delivered Meals
• Independent Living Waiver (Under Age 63)
• Home Modifications
• Adaptive Equipment
• Personal Care Attendant Services
• Assisted Living Waiver (under development)

14
Participant Involvement

• Each Participant
• Participates in Care Planning
• Chooses the the best options to meet the
  individual needs
• Type of Long-term Care
• Long-term Care Setting
• Provider of Care
• Directs Care the degree desired/capable

15
Provider Involvement

• State staff authorize Care Plan
• Determine and authorize amount of Care
• Providers partner with State Staff
• Care Plans are designed to Improve or Maintain
  Quality of Life
• Changes in circumstances are reported to State
  Staff
• Provider Nurses
• Conduct Assessments twice per year
• Provide Skilled Care in the Home as Necessary to
  Maintain Health
• Assist in investigations of Abuse/Neglect

16
Division of Senior Disability Services Staff

• Protecting Vulnerable Adults
• Hotline Investigations Intervention
• EDL Referrals
• Oversight of care delivery
• Expenditure Reports
• Complaint Investigations
• Provider Monitoring Sanctions
• Care Plan Adjustments
• Based on changes in circumstances and newly
  established unmet needs

17
Current HCBS Stats

• Average Monthly Intake
• Hotlines per month 1,489.92 investigations
• Per worker 54.24 (4.52/worker/month)
• Referrals per month 1,354.33 completed
• Per worker 49.31 (4.11/worker/month)
• Care Plan Adjustments
• Per month - 3,020.58

FY07 Summary 51,500 Total Clients authorized for
In-home Services 10,000 Total Consumers
authorized for Consumer Directed Care