FY 2006: Medicaid Expenditures for Institutions versus Community- Based Services, Information Bulletin # 216 (8/07).

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 Institution PD Institution
vs Community 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

Massachusetts $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/A $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.

Courtesy of Steve Gold: http://www.stevegoldada.com/