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The Generations Project. Working to inform, educate, organize, and offer creative solutions to rebalance Indiana’s long term care system. Established in 2001. AARP Indiana Alzheimer’s Association The Arc of Indiana Citizens Action Coalition of Indiana CICOA, Aging & In-Home Solutions.

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The generations project

The Generations Project

Working to inform, educate, organize, and offer creative solutions to rebalance Indiana’s long term care system

Established in 2001

Collaborating partners

AARP Indiana

Alzheimer’s Association

The Arc of Indiana

Citizens Action Coalition of Indiana

CICOA, Aging & In-Home Solutions

COVOH - Council of Volunteers and Organizations for Hoosiers with Disabilities

Indiana Alliance for Retired Americans

Indiana Association of Area Agencies on Aging

Mental Health Association in Indiana

United Senior Action of Indiana.

Collaborating Partners

The issue

The Issue

  • Rebalancing Indiana’s public spending for long term care: Medicaid

  • Balancing spending on home and community-based services with spending on institutional care.

  • Quality of Life Issue

  • Wise use of public money

  • Providing services that are preferred

Critical constituencies


Persons with disabilities


Service Clubs

Neighborhood & senior centers

Labor & retirees

Business organizations


Local Neighborhoods

Faith-based organizations

Critical Constituencies



  • Spring 2003:

    • Passage and signing into law of Senate Enrolled Act 493

  • Spring 2004:

    • Little or no progress on behalf of state to implement the law. Delays, excuses.

Long term care

Long Term Care

Rebalancing Indiana’s Long Term Care System

June Holt, Outreach Coordinator The Generations Project

Long term care1

Long Term Care

  • What is long term care?

  • Who needs long term care?

  • Where do people prefer to receive LTC?

  • Who pays for LTC?

  • Why should we be concerned about long term care?

Defining long term care

Defining Long-Term Care

  • Long term care encompasses a broad range of help with daily activities that chronically disabled individuals need for a prolonged period of time

    • Primarily low-tech services

    • Assistance with ADLs and IADLs

    • Hands-on or supervisory human assistance

    • Assistive devices

    • Home modifications



What are they talking about?


Some terms you should know.

Choice program

CHOICE Program

  • Community & Home Options to Institutional Care for the Elderly & Disabled

  • Totally funded by state of Indiana

  • Served 10,000 in 1999

  • Model program for home care

  • HCBS = Home & Community Based Services

Medicaid waivers

Medicaid Waivers

  • Allow Indiana to provide a variety of in-home and community-based services to individuals who would otherwise require the level of care provided in an institutional setting

  • Each client is assigned to a “waiver slot”

    • One can not receive services unless assigned to a waiver slot

  • Served 7,615 in FY 2002

Ssi supplemental security income

Pays monthly benefits to the poor who are blind, disabled or elderly.

2003 SSI:

$552/month for individual

300% SSI = $1656

Used as a qualifying amount for Medicaid services

SSISupplemental Security Income

Sea 493 long term care reform act

2003 Senate Bill 493

A bill designed to rebalance the way Indiana spends Medicaid dollars on long term care.

Passed without a negative vote by Indiana House and Senate

Senate Enrolled Act 493: SEA 493

Signed into law in May 2003

Public Law 274-2003

IC 12-10-11.5

SEA 493:Long Term Care Reform Act

Institution or home

Institution or Home?

System is out of balance

System is out of balance

2002 Medicaid funds

  • Indiana spent $1.1 billion on institutional care

  • Indiana spent $194 million for home and community based care

  • HCBC costs taxpayers 65-80% less than institutional care

Annual tax dollars in millions spent on long term care in indiana 2001 2002

Annual tax dollars in millions spent on long term care in Indiana (2001/2002)

$1.174 billion

$194 million

Indiana long term care costs

Indiana long term care costs

Balanced spending in other states

Balanced spending in other states

Hoosiers prefer home care

Hoosiers prefer home care

  • More than 27,000 on waiting lists for HCBC

    • Many qualify for NH bed but don’t want to go

  • Many empty nursing home beds

    • In 2001 nearly 25% of nursing homes were empty

  • #1 reason to get off waiting list is death

  • #2 reason is going into nursing home

Why has this happened

Why has this happened?

  • Used to think NH or institutional care was best for the disabled – young or old

  • Laws written with “Institutional Bias”

    • Mandated NH/institutional care

  • These laws have created barriers for low income Hoosiers to receive HCBC

  • Laws force many into nursing homes who would be better served at home

Sea 493 the law

SEA 493: The Law

Rebalances the way public money (Medicaid) is spent on long term care

Eliminates barriers

Eliminates barriers

  • Allows Medicaid dollars to follow the client from nursing homes to home care.

  • Makes the income eligibilitystandard for Medicaid home care services the same as for nursing home care at 300% of SSI.

  • Directs the state to apply for an additional 20,000 Medicaid waiver slots.

Supports families

Supports families

  • Protects the spouse from becoming impoverished when services are provided at home.

  • Establishes a caretaker support program.

  • Expands services to include personal care services and more.

Respects the person

Respects the person

  • Expands client rights under Medicaid waivers.

  • Establishes the right to self-directed care.

  • Establishes a comprehensive array of home and community based services.

Provides for future needs

Provides for future needs

  • Indiana must establish a system of integrated services to facilitate Home and Community-based care including:

    • Improved transportation,

    • More choices in housing

    • Enhanced education

    • Expanded workforce development

Implementation of the law

Implementation of the Law

  • Indiana is slow in implementing this law

  • Waiting lists are too large and are growing

  • People are dying instead of getting the care they need and deserve.

2004 legislation

2004 Legislation

  • Passed Senate Bill 449

  • Gives Health Finance Commission (Joint Senate & House committee) the charge to monitor implementation of SEA 493

  • Will allow legislators to follow the implementation process of SEA 493

Opportunities for hoosiers

Opportunities for Hoosiers

  • Keep the issue alive until the law is working for us

  • Let the governor and your legislators know that you want this law to be implemented as quickly as possible

  • SEA 493 will save lives and save money

Questions discussion action

Questions, Discussion & Action

Call the Governor at

317-232-4567 or

E-mail at [email protected]

  • Ask him to implement SEA 493, the Long Term Care Reform Act of 2003

  • It’s good for taxpayers, it’s good for the state and it’s what Hoosiers want

Rebalancing indiana s long term care system sea 493 it s the law

Rebalancing Indiana’s Long-term Care SystemSEA 493: It’s the law!

Thank You

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