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IL-Net Presents… Federal Opportunities to Expand Community Living in Your State A National Teleconference Wednesday, August 26, 2009 3:00 PM – 4:30 PM EDT. Today’s Discussion. Update on Money Follows the Person Administration on Aging Community Living Program

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IL-Net Presents…

Federal Opportunities to Expand Community Living in Your State

A National Teleconference

Wednesday, August 26, 2009

3:00 PM – 4:30 PM EDT


Today s discussion
Today’s Discussion

  • Update on Money Follows the Person

  • Administration on Aging Community Living Program

  • Veterans Administration – Home and Community-Based Services Program


Money follows the person
Money Follows the Person

  • Major initiative under the Deficit Reduction Act of 2005 (DRA)

  • Intent – Move Medicaid enrolled individuals from institutions to community

  • Authorized $1.7 billion in grants to states

  • Selected 31 states in 2007 (AR, CA, CN, DC, DE, GA, HI, IA, Il, IN, KA, KE, LA, MD, MI, MS, NC, ND, NE, NH, NJ, NY, OH, OK, OR, PA, SC, TX, VA, WA and WI)

  • Program will last 5 years 2007 – 2011

  • Report to Congress 2012


Who will transition
Who will Transition?

  • Originally 38,000

  • Revised Down 34,000

  • Ranges from a high in IL of 3,357 to low 100 in DE

  • Breakdown:

    • 605+ (48%)

    • Younger Persons with Disabilities (26.3%)

    • Individuals with Intellectual or Developmental Disabilities (19.3%)

    • Individuals with Mental Illness (3.8%)

    • Dually Diagnosed (3.1%)


Money follows the person expectations
Money Follows the Person Expectations

  • Congress will have reliable data on transitioning experience for first time

    • Do we have enough positive information to change the Social Security Act?

    • Should Congress require states to rebalance budgets?

  • Strong emphasis on self direction and consumer participation

  • System back-up plans


Money follows the person expectations cont d 2

Mathematica will evaluate:

Effectiveness of transition services

Health outcomes – do individuals living in the community fare better?

Goals of application/proposals met

System rebalanced

Program implemented as intended

Understand Cost impact – Are we saving money?

Redefine Home Setting:

Must have control over coming and going

No locked doors

Access to community 24/7

No congregate eating

May include no more than 4 individuals

Excludes assisted living

Money Follows the Person Expectations, cont’d 2


Early lessons learned
Early Lessons Learned

  • States with Previous Experiences are Farther Along

  • Housing is a Major Challenge

    • Dedicated Housing Specialist

    • Communication with Public Housing Authorities

    • Use of Web-based Housing Register

    • Develop a Housing Task Force

  • Enrollment Slow – 1,505 (12/08) Should be 4,250

    • State Economic Conditions - Budget Crisis

      • Hiring Freezes

    • Targeting Criteria


Early lessons learned cont d 2
Early Lessons Learned, cont’d 2

  • Lack of consistent and enthusiastic state leadership

  • Wait lists for waiver slots

  • Resistance by the provider community (facilities and institutions)

  • Assuring advocates have access to residents



Administration on aging
Administration on Aging

  • Deficit Reduction Act of 2005 – Positioned the Administration on Aging

  • In 2007 the Administration on Aging awarded 12 states diversion grants of $500,000 each ($8.8 Million)

  • In 2008 new grantees added 14 additional states ($16.2 Million)

  • In 2009 – 30 letters of intent – Due August 3, 2009

  • 35 Proposals received – may award 18 grants


Community living program
Community Living Program

  • Congress Says – Modernize & Transform Current System

  • Use Older Americans Act and other Non-Medicaid Funding

  • Create flexible, self-directed service dollars

  • Complements the Money Follows the Person Initiative

  • Supports state long-term service rebalancing efforts


Hoping to achieve
Hoping to Achieve

  • Flexible dollars to ensure that services can be tailored to individualized needs of consumers and family caregivers, rather than being tied to particular service or set of services

  • Criteria to target individuals to ensure the program actually serves those who are most at risk of nursing home placement and spend down to Medicaid

  • Offering options to provide full choice and control of received services

  • Strategies that complement and support rather than supplant the on-going efforts of family members


Connecting the dots
Connecting the Dots

  • Partnership Opportunities

  • Cross Disability Training

  • Understanding Independent Living Movement/Self-Direction

  • Increased Service Population - Persons with Disabilities are Growing Older

  • Caregiver Support – Often with Disabilities

  • Opportunities for Community-Based Growth

  • ADRC Collaboration – Community Resources



Veterans administration va
Veterans Administration (VA)

  • Twenty-four million Americans are Veterans

  • Veterans Administration Provides Health Care Benefits & Financial Support to Eligible Veterans

  • Veterans Health Administration – Largest Health Network in America – Payer & Provider

  • VA Medical Centers (1,300) Acute Care & Institutional Care


Va long term services
VA Long-Term Services

  • 9% of Total Budget

  • Expends $3.9 Billion in Nursing Homes (84% of Long-term services budget)

  • VA Nursing Homes (75%), Community Nursing Homes (12%), & State-Managed Nursing Homes (13%)

  • 15% on non-institutional services

  • VA’s Health Care Expenditures


Increased need
Increased Need

  • Conflicts in Middle East – Number of Younger Vets with Disabilities is Increasing

    • Post-Traumatic Stress Disorder

    • Traumatic Brain Injuries

  • Growing Roles


Existing home community based programs
Existing Home & Community-Based Programs

  • Home Improvements & Structural Alterations Grant

  • Wounded Warriors

  • Aid and Attendance

  • Out-Patient Clinics


New program veterans directed home and community based services
New Program – Veterans-Directed Home and Community-Based Services

  • In 2008, Federal Collaboration - Partners include the Aging Network (consisting of State Units on Aging (SUAs) with Area Agencies on Aging (AAAs)) and Veterans Administration Medical Centers

  • Serves Veterans of all ages at risk of nursing home placement

  • The VA will deliver the Veterans-Directed Home and Community-Based Service Program (VDHCBS) in 20 states and will invest approximately $10 million to serve veterans at risk of institutionalization

  • The VA will directly purchase services through SUAs and/or AAAs for the VDHCBS program

  • Offers a flexible budget to purchase services to live in the home


What type of services
What Type of Services? Services

Cash and Counseling program

Service Offering:

  • Personal Care (physical or verbal assistance with eating, bathing, dressing, grooming or transferring)

  • Homemaker (cleaning, laundry, meal planning and preparation or shopping)

  • Adult day care

  • Assistive technology

  • Home delivered meals

  • Caregiver support

  • Respite

  • Environmental supports (yard care, snow removal, extensive cleaning)

  • Other goods and services needed to remain safely in home or community


Referrals
Referrals Services

  • Aging and Disability Resource Centers (ADRCs), AAAs, SUAs, or other entities may refer potential veterans who are eligible to the local VA Medical Center

  • Each participating VA Medical Center will establish protocol for determining eligibility


Implications for you
Implications for You Services

  • New Population Group for AAAs

  • Training on Independent Living Movement

  • Case Management Opportunities

  • Goods and Service Purchases

  • Networking

  • Others?


Questions answers2
Questions & Answers Services

23


Resources
Resources Services

  • [email protected]

  • www.hcbs.org/moreInfo.php/doc/2655

  • www.aoa.gov

  • http://www.hcbs.org/moreInfo.php/topic/202/doc/2640/Veterans-Directed_Home_and_Community_Based_Service


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