Rebalancing LTSS

1. Rebalancing LTSS 1

2. People far prefer to receive long-term services and supports (LTSS) at home and in the community. 2

3. Nationally, rebalancing efforts have reduced the proportion of LTSS spending on nursing facilities from 73.4% to 66.6% between 2004 and 2009. 3

4. 4

5. . . . and between 2004 and 2009, Maryland lost ground in rebalancing . . . 5

6. 6

7. While Maryland Medicaid’s payment rates to nursing facilities are higher than average. . . 7

8. 8

9. Maryland’s institutional bias isn’t a function of being overbedded in nursing facilities . . . 9

10. . . . and it isn’t a function of MD nursing facilities’ dependence on Medicaid (indeed, Maryland nursing facilities have a higher mix of “good” payers such as Medicare and private pay). . . 10

11. . . . and Maryland is not unusual in per capita spending on nursing facilities, where Maryland ranks 23rd (as compared with 40th in per capita HCBS spending).

12. So what’s going on? 12

13. Very low HCBS participation rates partially explain Maryland’s institutional bias . . . 13

14. 14 . . . and very low HCBS payment rates (relative to NFs) partially explains it.

15. 15

16. Lining up good policy andcost-effectiveness 16

17. 17 On a per capita basis, home and community-based services (HCBS) are less expensive to Medicaid than nursing facilities.

18. So, IF DONE RIGHT, rebalancing isn’t just good policy, it’s cost effective. Had Maryland served the same overall number of people in 2009, at the average rebalancing %, $326 million would have been saved. 18

19. Conclusion 19