Home Grown Money: How Home

1
Home Grown MoneyHow Home Community Based
Services Saves Maryland MillionsAdministrative
Funding the Older Adult Waiver

• A perspective from Marylands Area Agencies on
  Aging

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Basic Tenets of the Older Adult Waiver (OAW)

• It is a waiver from traditional reimbursement
  methodology for Medical Assistance services
• The waiver is granted by the Centers for Medicare
  and Medicaid Services
• The waiver is the responsibility of the
  Department of Health and Mental Hygiene (DHMH),
  the single state agency for Maryland
• The waiver is administered by the Maryland
  Department of Aging (MDoA) under a Memorandum of
  Agreement with DHMH

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Eligibility Criteria for the Older Adult Waiver
(OAW)

• Age Criteria
• Participants must be age 50 and over
• Financial Criteria
• Monthly income not greater than 2,022
• Assets cant exceed 2,000
• Technical / Medical Criteria
• Nursing home level of care

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Administration of the Older Adult Waiver

• MDoA administers the OAW through 19 Area Agencies
  on Aging (AAAs) throughout the State
• Administrative Funding is provided to the AAAs in
  the form of a pass-through grant from DHMH to
  MDoA to the AAA
• The Statewide level of Administrative Funding has
  actually dropped from its level of five years ago

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Administrative Funding FY 2005 - 2009
6
Administrative Pressures Today and Beyond

• Current caseloads range from the low 40s to as
  many as 80 or more cases per manager
• The erosion of administrative funds through
  inflation has exacerbated this situation
• The advent of Money Follows the Person (MFP) will
  only increase the time required to manage a case
• The need to provide quality care to our older
  adults and to successfully complete the MFP
  demonstration is the reason increased funding is
  needed

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A Funding Solution

• In our current economy, any expenditure needs to
  be prudent and justified
• Continued erosion of funding for administering
  the OAW could lead to staffing issues
• Staff turnover could increase, leading to decline
  in talent, ability and capability
• Increased caseloads could result in a greater
  chance for errors and omissions in care plans
• What appears to be fiscal responsibility becomes
  operational inefficiency

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A Funding Solution

• The means to fully fund administration of the OAW
  is already in place
• OAW services cannot be implemented unless it is
  shown they would be less than the cost of a
  Nursing Facility stay
• This amount, known as the cost neutrality factor,
  is currently in excess of 70K per year in
  Maryland
• A recent survey of Maryland AAAs shows
  significant savings in the OAW program in every
  jurisdiction in the State

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Per Client Costs vs. Per Client Savingsby
Jurisdiction
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A Solution we can live with

• The savings depicted in the preceding slide
  equate to more than 96 million per year
• Restore administrative funding to levels in FY
  2005 as adjusted for inflation
• This would translate to an increase of nearly
  500,000 per year in administrative funding
• This represents less than ½ of one percent of the
  total savings generated by the program each year
• Restore fiscal responsibility to administration
  of the OAW by annually increasing funding
  consistent with economic conditions and proven
  program results

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More about M4A

• The Maryland Association of Area Agencies on
  Aging (M4A) serves as a viable and effective
  advocate for older adults within Maryland,
  educating and instructing about aging issues in
  order to obtain an adequate and appropriate
  system of services at the state and local level.
  M4A also engages in activities that promote
  relevant research, training, policy development,
  and programs that provide assistance to
  caregivers of the elderly. Each Area Agency on
  Aging (AAA) designated by the Maryland Department
  of Aging is a member of M4A.
• M4A adheres to and promotes the Declaration of
  Objectives contained in Title I of the Older
  Americans Act of 1965, as amended, and assists
  older adults in securing equal opportunity to the
  full and free enjoyment of those objectives.
• For more information about M4A visit
• www.MD4A.org