1. HEALTH CARE AND HUMAN SERVICES POLICY, RESEARCH, AND CONSULTING—WITH REAL-WORLD PERSPECTIVE. Nursing Home Diversion June 2, 3009

2. www.lewin.com 2 Nursing Home Diversion Initiative A strategy that builds on the Aging Network’s existing work to develop comprehensive systems of community-based supports to help people live at home for as long as possible and avoid or delay spend-down to Medicaid and unnecessary placement in nursing homes. ► For every non-Medicaid individual diverted from a NH into the community the total savings in federal and state dollars is projected to be over $40,000 per year.

3. www.lewin.com 3 Nursing Facility Residents Per 1,000 individuals Age 65+, 2005 31-40 res. per 1,000* 14 – 30 res. per 1,00041-49 res. per 1,000 Connecticut Minnesota Illinois Nebraska Indiana North Dakota Iowa Ohio Kansas Rohde Island Louisiana South Dakota Massachusetts Alabama North Carolina Colorado South Carolina Delaware Texas Maine Vermont Maryland Virginia Michigan West Virginia New Jersey Alaska Oregon Arizona Nevada California New Mexico Florida Utah Hawaii Washington Idaho Arkansas New Hampshire District of Columbia New York Georgia Oklahoma Kentucky Pennsylvania Mississippi Tennessee Missouri Wisconsin Montana Wyoming 52 – 65 res. per 1,000 HI AK MT ID WA CO WY NV CA NMAZ MN KS TX IA WI IL KY TN IN OH MI ALMS AR LA GA FL SC WV VA NC MD DE PA NJ VT RI ME NH OR UT SD ND MO OK NE NY CT DC MA National Average = 40 per 1,000 individuals age 65+ Source: Mick Cowles (2006) Nursing Home Year Book for residents and Bureau of the Census for population.

4. www.lewin.com 4 © The Lewin Group Expect more than triple as many NF users in 2050 if NF use rates remained at 2004 levels

5. www.lewin.com 5 Trends in LTC Spending In 2006, over $150 billion was spent on LTC for seniors. ► 60% were public expenditures (Medicaid, Medicare, OAA and other public funding) In 2005, 62% of all long-term care resources for all ages were spent on institutional care

6. www.lewin.com 6 The US LTC System—Challenges Consumers are not aware of their LTC options Consumer LTC needs often arise during a crisis The LTC System is confusing, disjointed and difficult to access, navigate and manage LTC System designed around Medicaid/Medicare Inefficiencies in the system often lead to: ► Delays in obtaining appropriate care ► Unnecessary expenses, including institutionalization ► Unnecessary impoverishment and spend down to Medicaid

7. www.lewin.com 7 Slow the Rate of Growth of the Medicaid Program and Improve the Long-Term Care System ► Prioritize non-Medicaid home and community-based service funding to individuals who are not Medicaid eligible but at high risk of spend- down to Medicaid and institutionalization ► Efficiently and effectively target high-risk individuals through single- entry-point/ADRC systems ► Rapidly authorize and provide consumer-directed services that enable services to be tailored to individual’s unique and changing needs Nursing Home Diversion Strategy

8. www.lewin.com 8 Nursing Home Diversion Strategy Home/CommunityNursing Home Spenddown to Medicaid Low-Risk of NH Placement & Spenddown to Medicaid Medium-Risk of NH Placement & Spenddown to Medicaid High-Risk of NH Placement & Spenddown to Medicaid Long-Term Care Risk Groups

9. www.lewin.com 9 Effectively Target and serve High-Risk Individuals with Nursing Home Diversion Initiative via ADRC Single Entry Point to slow rate of growth of Medicaid Nursing Home Diversion Strategy Low-Risk of NH Placement & Spenddown to Medicaid Medium-Risk of NH Placement & Spenddown to Medicaid High-Risk of NH Placement & Spenddown to Medicaid Home/CommunityNursing Home Spenddown to Medicaid Long-Term Care Risk Groups

10. www.lewin.com 10 Nursing Home Low-Risk of NH Placement & Spenddown to Medicaid Medium-Risk of NH Placement & Spenddown to Medicaid High-Risk of NH Placement & Spenddown to Medicaid Nursing Home Diversion Nursing Home Diversion Strategy Home/Community Spenddown to Medicaid

11. www.lewin.com 11 System Components of NHD Single Entry Point/Aging and Disability Resource Center Opportunity for Consumer Direction Financial Management Service Entity (FMS) or Fiscal Intermediary (FI) Flexible Services

12. www.lewin.com 12 Process That Led to VDHCBS Awareness of NHD Initiative and Grant Announcement Awareness of VHA Desire for Consumer Direction for Veterans of All Ages Development of VDHCBS Program and incorporate as Attachment I of NHD Grant Announcement Award NHD grants 9/30/08 and identify 10 states/AAA’s that will work with VISNs and VAMC to roll-out VDHCBS

13. www.lewin.com 13 Medicaid and Nursing Home Diversion Initiative NHD Grant Award-Only StatesNHD & VDHCBS Award States GeorgiaArkansas IllinoisConnecticut KentuckyFlorida LouisianaMassachusetts MarylandMichigan MinnesotaNew Jersey New HampshireNew York OhioTexas VermontVirginia West VirginiaWashington

14. www.lewin.com 14 Lisa Alecxih Senior Vice President Center for Long Term Care The Lewin Group 3130 Fairview Park Drive Suite 800 Falls Church, VA 22042 (703) 269-5542 www.lewin.com The Lewin Group | Health care and human services policy research and consulting | www.lewin.com www.lewin.com 3130 Fairview Park Drive, Suite 800 Falls Church, VA 22042 From North America, call toll free: 1-877-227-5042 inquiry@lewin.cominquiry@lewin.com The Lewin Group is an Ingenix Company. Ingenix, a wholly-owned subsidiary of UnitedHealth Group, was founded in 1996 to develop, acquire and integrate the world's best-in-class health care information technology capabilities. For more information, visit www.ingenix.com. The Lewin Group operates with editorial independence and provides its clients with the very best expert and impartial health care and human services policy research and consulting services. The Lewin Group and logo, Ingenix and the Ingenix logo are registered trademarks of Ingenix. All other brand or product names are trademarks or registered marks of their respective owners. Because we are continuously improving our products and services, Ingenix reserves the right to change specifications without prior notice. Ingenix is an equal opportunity employer. Original © 2008 Ingenix. All Rights Reservedwww.ingenix.com