building a roadmap for financing long- term services & supports melding private insurance, a...

Building a Roadmap for Financing Long-Term Services & Supports

Melding Private Insurance, a Contribution Program and Medicaid into a Cohesive Proposal – Part II

Long-Term Care Financing Advisory Committee

December 10, 2009

Medicaid expansion cost estimates were developed specifically for this presentation, and should not be used for other purposes.

2

Overview of presentation Update on Public Awareness Campaign

Intersecting Activities

Review and Preview

The Analysis Setting the Stage Cost Avoidance to Medicaid from Private Financing Mechanisms Cost of Medicaid Expansions

Preliminary View of the Roadmap

Committee Business

Appendix

Note: All numbers are rounded in this presentation.

3

Section 1

Update on Public Awareness Campaign

4

Section 2

Intersecting Activities

Background

As part of the Commonwealth’s Community First Olmstead Plan, the Advisory Committee is tasked with identifying strategic options for reforming the financing system for LTS in Massachusetts

The Advisory Committee has identified several issues that are integrally related to LTS financing, but are outside of the Advisory Committee’s scope of work: Affordable and accessible housing Employment Workforce capacity and development Transportation Integrated financing and care delivery Administrative activities Public awareness and access to information Consumer choice

5

Olmstead Plan and other initiatives

Other Olmstead Plan and state initiatives that address these “intersecting activities” are in process across the Commonwealth. Responsible parties include: System Transformation Grant Work Without Limits Initiative (formerly MI-CEO grant) Cross-agency and cross-Secretariat workgroups Community organizations PCA Workforce Council

The Advisory Committee recognizes that the Commonwealth’s Community First goals cannot be met through improved financing alone: Successful implementation of the Advisory Committee’s financing

recommendations is contingent upon the success of these other initiatives (and vice versa)

6

Proposed endorsing statements

The Advisory Committee endorses the following initiatives and activities that support its core principles:

Increase the availability of affordable and accessible housing;

Promote employment of people with disabilities; encouraging the state to lead this effort by becoming a model employer;

Promote a high-quality and stable direct care workforce;

Increase the availability and coordination of local transportation options for people with disabilities and elders;

7

Proposed endorsing statements (2)

Support a care delivery system that coordinates all services and integrates financing for people with chronic care needs;

Enable more effective care coordination through infrastructure improvements that expand the use of health information technologies and build capacity for information exchange;

Promote public and provider awareness about LTS and planning for future LTS needs; ensuring that all information is available in accessible formats for people with disabilities and elders; and

Increase consumer choice in the LTS delivery system.

8

Next steps on intersecting activities

Other activities or initiatives to add?

Revise and finalize endorsing statements

In final report, we will characterize these issues specifically as they relate to LTS financing

9

10

Section 3

Review and Preview

Recap of last month Developed more affordable private LTC insurance model (for Partnership)

targeted at middle income Based on Federal LTC Insurance Program Group coverage with portability requirements may be important to

increase take-up rates

Modeled mandatory contribution program and analyzed premiums necessary for solvency (tenuous)

Federal CLASS program uses auto-enrollment with voluntary opt out – estimated take-up rate of 5%

Discussed need to refine proposals based upon more realistic “take-up” rates

Began to assess impact on Medicaid (cost avoidance due to delaying or preventing Medicaid spend-down)

11

12

Today’s presentation

Presentation on Medicaid cost avoidance from: Federal CLASS program State contribution program LTC Partnership program

Begin to present numbers on Medicaid expansion costs Expand access to HCBS for people with disabilities and seniors Expand Medicaid eligibility for seniors New state Medicaid buy-in program

Take away points from today’s presentation

Federal CLASS program and LTC Partnership Take-up rates from voluntary programs too low to make a meaningful

impact on Medicaid Programs do not address needs of people who spend-down Small part of the solution; tinkering around the edges

Mandatory state contribution program breaks the cycle A bigger splash, but is another mandate feasible? Subsidies would increase take-up rates, but are they affordable?

Without Medicaid expansion, still have significant unmet need among lower middle class and likelihood of spend-down

13

14

Section 4a

The Analysis: Setting the Stage

Setting the stage for the numbers

Focus on the Medicaid budget for seniors & adults with disabilities $4.6 billion on all services, including waiver services 75% of the $4.6 billion – or $3.6 billion – spent on LTS 45% of the $4.6 billion – or $2.0 billion – spent on institutional care Note: State share = $2.3 billion / Federal share = $2.3 billion

Medicaid coverage levels today Medicaid seniors & adults with disabilities: 8.5% of MA population

(25 years & older) Seniors = 126,000 or 14% of MA population age 65+, including those who

are eligible for Medicaid by meeting the standards through spend-down Adults with disabilities = 240,000 or about 80% of MA population of

adults with disabilities

Potential risk pool = those seniors and adults with disabilities not on Medicaid (key to estimating take-up rates, woodwork effect, etc.)

15


Medicaid cost avoidance and Medicaid expansion costs depend on population distribution by income and need

16


University of Massachusetts Medical SchoolEBD Consulting Services, LLC 17

Section 4b

The Analysis: Medicaid Cost Avoidance

Medicaid cost avoidance: minimal to substantial

Key question: What is the net effect on the Medicaid budget? Depends on:

How many persons who use Medicaid would be covered by federal CLASS, state contribution or private LTC insurance with Partnership? (depends on income and health, personal preferences, and program construct)

The value of the non-Medicaid coverage People’s level of need (low, medium, high risk)

Parameters & data sources around the estimating process “Base” case estimates = best estimates of cost avoidance to Medicaid

based on best available data sources (ACS, CBO, Census, MassHealth, other states’ experiences, published literature)

“Low” and “High” case estimates reflect uncertainty around assumptions included in the base estimates

18

All of these financing mechanisms provide some Medicaid cost avoidance

19

Federal CLASS

State Contribution, Mandatory for Everyone;

assumes subsidies for those above 2% income

premium test

State Contribution, Mandatory for those

who meet 2% income premium

test

Partnership LTC Insurance

Eligible Persons a/ 4,377 4,377 4,377 4,077 Covered Persons b/ 219 4,377 2,659 283 Take-Up Rate c/ 5.0% 100.0% 60.7% 6.9%

COST AVOIDANCE ($ millions) d/Low $42 ($86) $9 $21Base $59 $235 $22 $41High $77 $555 $37 $62Cost of Subsidy (state only?) ($1,200)

Current Medicaid Spending ($ millions) e/ $4,670 $4,670 $4,670 $4,670

COST AVOIDANCE as a % of Medicaid SpendingLow 0.9% -1.8% 0.2% 0.4%Base 1.3% 5.0% 0.5% 0.9%High 1.6% 11.9% 0.8% 1.3%

State-Share of Medicaid Spending only ($ millions) f/Low $21 ($43) $5 $10Base $30 $117 $11 $21High $38 $278 $18 $31

a. Eligible persons = total number of persons in Massachusetts age 25 and older.b. Covered persons = total estimated number of persons insured under each option.c. Take-up rate = calculated rate of insurance based upon num. of eligible persons and den. of covered persons.d. Cost avoidance = value of reductions in Medicaid spending per the design of the option, net of state cost for subsidiese. Medicaid spending = FY 2008 spending on seniors and adults with disabilities.f. State share of spending = 50% of Medicaid spending to reflect state share of the Medicaid program costs.


Key program features & assumptions

20

Federal CLASS Program State Contribution Program LTC Partnership Program

Program Design &AssumptionsParticipation Voluntary opt-out Mandatory for all with subsidies

&Mandatory only for those meeting

2% affordability test

Voluntary

Eligible population All persons age 25+ (modeled here)

All persons age 25+ (modeled here)

All persons age 25+ (modeled here)

Daily benefit amount

$50-$100 “cash daily”,based upon level of need

$50-$100 “cash daily”,based upon level of need

$100 per day

Benefit Lifetime, after 5 years of vesting Lifetime, after 5 years of vesting 2-year policy

Pays for? Non-medical community LTS All LTS All LTS

Annual premiums $1,750 $1,200Reduced by subsidiesif mandatory for all

Depends on age

Take-up rate 5% 100% with subsidies60% without subsidies

Specific to each age group;5% across all age groups

Participant Base Adverse selection Broad base Middle-income assumed to participateExcludes people with disabilities

Cost Avoidance: Under the Federal CLASS Program

Cost-avoidance calculations CBO analysis assumes 1.7% in Medicaid cost avoidance based upon

take-up rates of 3-5% Base case: 1.7% Medicaid Cost Avoidance applied against base of MA

Medicaid LTS Spending Low and High cases: 1.2% and 2.2% applied against base of LTS

spending

Subsidies – Not included. May wish to consider subsidies for lower middle income individuals, if permissible under federal CLASS program

21


Cost Avoidance: Under a State Contribution Program

Cost-avoidance calculations Modeled cost avoidance in 3 areas:

1. Contribution pays for some community LTS before Medicaid (small adjustment; assumes these are mostly new services)

2. Providing community LTS delays entry into nursing facility (assume 3 months)

3. Contribution is the primary payer for nursing facility costs, Medicaid wraps (after the 3 month delay)

Base case: Assumes that Medicaid payments for Community LTS decline 40% and that the Contribution $100 daily benefit meets 70% of nursing facility costs

Low case: Assumes Medicaid Community LTS decline 20% and Contribution benefit meets 60% of nursing facility costs

High case: Assumes Medicaid Community LTS decline 60% and Contribution meets 80% of nursing facility costs

Subsidies – estimated for individuals for whom the Contribution premium exceeds 2% of income. Subsidies would be a new state cost.

22


Cost Avoidance: Under the LTC Partnership Program

Cost-avoidance calculations Obtain savings if people are covered by private insurance who

otherwise would have spent down to Medicaid. Assume these are lower middle income individuals.

Calculations based on California’s experience and program structure Base case: Assumes 1% of policyholders would have spent down to

Medicaid Low case: Assumes .5% would have spent down High case: Assumes 1.5% would have spent down

Changes to the insurance market that increase take-up rates could also increase Medicaid cost avoidance (e.g. NAIC consumer protections, increase group coverage, make group coverage portable, etc.)

Subsidies – not estimated

23

Section 4c

The Analysis: Medicaid Expansions

24

Recap from May: MassHealth financial eligibility rules create significant access inequities

Income Assets

$0

$2,000

$4,000

$6,000

$8,000

$10,000

Ass

et L

imit

$109,560

Community spouse of nursing home resident

CommonHealth

Elderly couple, not N.F. level of care

Single

0%

50%

100%

150%

200%

250%

300%

350%

Perc

enta

ge o

f Fe

dera

l Pov

erty

Lev

el

maximum

minimum

MassHealth income standard for deductible Elderly eligibility, MassHealth Standard Non-elderly disabled eligibility, MassHealth Standard Community spouse of nursing home resident CommonHealth

25

Recap from May: Medicaid benefit coverage rules leave gaps in access to key LTS

Medicaid state plan covers various medically necessary services: Institutional care (NF, ICF-MR, chronic/rehab hospital) Community-based services: personal care services (special eligibility rules), home

health, private duty nursing, adult foster care/group adult foster care, adult day health, day habilitation, hospice, therapies, prosthetics, orthotics, DME/oxygen

4 HCBS Waivers* cover a wide range of additional community-based supports only for targeted groups at an institutional level of care (frail elders, adults with MR, adults with traumatic brain injury, children with autism): Examples: homemaker, respite, individual supports, companion, chore, home

delivered meals, laundry, medication management, NF transition assistance, grocery shopping and delivery, transportation, residential habilitation, assistive technology, supported employment, home adaptation…

26*Funded through state agencies, but expenditures eligible for federal Medicaidreimbursement.

Medicaid expansions: Gaps in coverage

Key question: What is the net effect on the Medicaid Budget? New Services – Expand access to HCBS for adults with disabilities &

seniors More Users – Expand eligibility for seniors (0-200% & 200-299%) New Medicaid Program Design – Buy in for Seniors

Parameters & data sources around the estimating process “Base” estimates = best estimates of Medicaid expansion costs based on

best available data sources (MassHealth, Census, ACS, SCO evaluation)

“Low” and “High” estimates reflect uncertainty around assumptions included in the base estimates

Conservative estimating process overall

27


Medicaid expansions - Gaps in coverage

Three ways to expand Medicaid:

# 1. Expand access to HCBS Non-medical LTS for adults with disabilities & seniors Estimated increase based on number of new users. No offsets were

taken.

# 2. Expand eligibility for seniors More seniors eligible due to increase in income eligibility test; Estimate senior population not enrolled in Medicaid today Numbers incomplete on increasing asset limit [more information at next

meeting]

# 3. New program – Buy in to Medicaid using assets Allow people to buy into Medicaid with their assets Numbers incomplete on this option [more information at next meeting]

28

Assumptions used to calculate the cost of the gaps in coverage

# 1. Expand access to HCBS Non-medical services for adults with

disabilities & seniors Estimated increase based on number of

new users. No offsets were taken.

Assumes that all adults with disabilities & seniors will use HCBS

Assumes that the average cost for HCBS is $13,200 for eligible seniors and $35,000 for eligible adults with disabilities

Low, base, and high cases built around average cost estimates that are 25%, 50%, and 75% of the risk of the average for current users

#2. Expand eligibility for seniors 0-200% FPL eligible 200-299% FPL eligible [Remove asset test as a barrier to eligibility

for seniors] [next meeting]

Assumes that a certain percentage of all seniors in both income groups are not eligible for Medicaid but will be under this expansion option

Base case applies MassHealth average cost per member per year by level of need: Nursing Facility resident: $55,600; Community state plan LTS user: $12,100; Community Well (acute care only): $2,000;

Low and high cases are 20% above and below base case because of uncertainty of the assumptions

29


Options for Medicaid expansions: broad parameters to demonstrate order of magnitude ($ millions)

30

# Individuals Low Case Base Case High Case

Expand access to HCBS

Provide HCBS to MassHealth seniors, age 65+, with self-care needs (2+ ADLs)

12,000 $40 $80 $160

Provide HCBS to select group of 10,000 members with disabilities a/

10,000 $90 $180 $360

Provide HCBS to MassHealth Commonhealth members, age <65

15,000 $130 $260 $530

Provide HCBS to ALL MassHealth Standard members with disabilities

207,000 $1,810 $3,630 $7,260

Expand eligibility for seniors

Increase income eligibility for seniors to 200% FPL 205,000 $800 $1,000 $1,200

Increase income eligibility for seniors 200-300% FPL

168,000 $600 $700 $800

Increase asset limit for seniors to $xx

a. Cost would vary depending on population selected, level of need, and program structure

Estimate to be determined. The asset test is key for eligibility for most seniors. This could be a very large number, depending on the new asset limit.


#3. New program - Buy-in to Medicaid using assets

Why consider a new Medicaid program? Medicaid expansion of spending gives you 50% FFP Purchasing power of Medicaid Typical expansions reduce any incentive that middle-income have to plan for

future A buy-in might give them a way to save and avoid the delay in receiving care as

well

Target Population Elderly persons living in the community Persons who cannot easily afford private insurance Assets would exceed community asset requirements

How would such a program work? Put liquid assets to good use

31


Section V

Preliminary View of the Roadmap

32

Preliminary roadmap: short-term activities

Short-term (Years 1-2):

1. Support enactment and implementation of NAIC model act and regulations

2. Develop comprehensive and large-scale LTS education and awareness campaign about all public and private LTS financing mechanisms

3. Provide additional support for informal caregivers around training and support groups

33

Preliminary roadmap: short- to medium-term activities

Short- to Medium-term (Years 2 and 4)

1. Pursue development of LTC Partnership program (state legislation with design specifications that meet our goals)

2. Pursue other insurance reforms1. Promote group coverage of private LTC insurance with

portability (Recommendation re: GIC?)

2. Develop FDIC-like mechanism to insure policies against risk of insurer solvency

3. Develop modest Medicaid HCBS and eligibility expansions

4. Support activities to increase participation in federal CLASS program (assuming it passes)

34

Preliminary roadmap: long-term activities

Long-term (Years 4-8):

1. Pursue broader Medicaid service and eligibility expansions

2. Establish mandatory state contribution program (determine relationship to federal CLASS program if it passes)

3. New Medicaid buy-in program (determine relationship to contribution program)

4. Additional support for informal caregivers

35

Section VI

Committee Business

36

Committee Business

Public input process Dates TBD (early February 2010?):

Eastern MA Western MA

Next meeting Date: Thursday, January 7th, 2010 from 9:00 -11:30am Location: One Ashburton Place, 21st Floor

Future meeting reminder Additional meeting scheduled for Thursday, February 25th

37

Appendix

38

LTS financing principles

The reformed LTS financing system will:

Ensure a strong public safety net for the poor and most vulnerable.

Limit financial pressure on the state financing system so that state funds are preserved for those most in need.

Encourage personal responsibility for financing LTS to the maximum extent possible.

Enable middle income people of all ages to access the LTS they need without becoming impoverished.

Ensure appropriate participation of and support for informal caregivers.

39

The big picture on cost avoidance

40

COST AVOIDANCE, ANNUAL COSTS IN STEADY STATE (2008 DOLLARS) - BASE CASE (MIDDLE) ASSUMPTIONS

(dollars in millions) Federal CLASS

State Contribution: Mandatory for Everyone -

Premium Subsidies for Lower Income

State Contribution: Mandatory for Persons who

meet 2% Premium Test LTC Partnership

Cost Avoidance: Total Federal & State (a) (in millions) 78.5$ 1,447.5$ 21.6$ 41.1$

Cost Avoidance: State-Share Only (b) 39.3$ 723.8$ 10.8$ 20.6$

Massachusetts Population (in thousands) 6,470 6,470 6,470 6,470

Massachusetts Population - Target 25 years + 4,380 4,380 4,380 4,380

MassHealth Membership 370 370 370 370

Projected Policyholders (not necessarily MassHealth Members) 220 4,380 2,660 280

Policyholders as a % of Massachusetts Population - Target 25 years + 5.0% 100.0% 60.7% 6.4%

Cost Avoidance per person in Massachusetts

Cost Avoidance: Total Federal & State (a) 12$ 224$ 3$ 6$

Cost Avoidance: State-Share Only (b) 6$ 112$ 2$ 3$

Cost Avoidance per MassHealth member

Cost Avoidance: Total Federal & State (a) 212$ 3,912$ 58$ 111$

Cost Avoidance: State-Share Only (b) 106$ 1,956$ 29$ 56$

Cost Avoidance per Policyholder

Cost Avoidance: Total Federal & State (a) 357$ 330$ 8$ 147$

Cost Avoidance: State-Share Only (b) 178$ 165$ 4$ 73$

Total Medicaid Spending in FY 2008 (Federal & State) (a) 4,670.0$ 4,670.0$ 4,670.0$ 4,670.0$

Total Medicaid Spending in FY 2008 State-Share Only (b) 2,335.0$ 2,335.0$ 2,335.0$ 2,335.0$

Cost Avoidance as a percent of Total Medicaid Spending 1.7% 31.0% 0.5% 0.9%


State contribution with subsidies takes the lead in take-up rates

41

Medicaid Bound Tweeners Low Tweeners HighFinancially Independent Total

$0- $24,999 $25,000 - $49,999 $50,000 - $99,999 $100,000 + All IncomesFPL Range Up to 230% FPL 230% - 460% 460% - 915% Above 915% FPL

Massachusetts Population 25+ 878,978 839,621 1,360,011 1,298,788 4,377,398 Massachusetts Population 25+ 20% 19% 31% 30% 100%Take-Up Rates (persons)Federal CLASS - 109,435 109,435 - 218,870 State Contribution, w/Subsidies 878,978 839,621 1,360,011 1,298,788 4,377,398 State Contribution, w/o Subsidies - - 1,360,011 1,298,788 2,658,799 LTC Partnership Insurance - 93,315 93,315 93,315 282,774 Take-Up Rates (percent)Federal CLASS 0% 13% 8% 0% 5%State Contribution, w/Subsidies 100% 100% 100% 100% 100%State Contribution, w/o Subsidies 0% 0% 100% 100% 61%LTC Partnership Insurance 0% 11% 7% 7% 6%


Where there is a will, there is a way: lower the subsidies

Loss of federal share (50%) challenge to state contribution

State Contribution, Mandatory for Everyone; assumes

Subsidies for those above 2% income premium test

Breakeven: What if we only subsidized Medicaid Bound?

3% Target

State Contribution, Mandatory who meet 2% income premium

test. NO SUBSIDIES

Eligible Persons 25 years of age + 4,377 4,377 4,377 Covered Persons 4,377 4,377 2,659 Take-Up Rate 100% 100% 61%

Cost Avoidance (in millions) State Share a/Low 883.95$ 883.95$ 4.70$ Base 723.75$ 723.75$ 10.80$ High 563.55$ 563.55$ 18.25$

Cost of Subsidies (in millions) up to 2% b/ 1,213$ -$ -$ Cost of Subsidies (in millions) up to 3% b/ 788.2 -$

Cost Avoidance Net of Subsidies (in millions) Low (329.05)$ 95.75$ 4.70$ Base (489.25)$ (64.45)$ 10.80$ High (649.45)$ (224.65)$ 18.25$

a. Cost avoidance = Value of reductions in Medicaid spending to State as a result of the design of the option.b. Cost of subsidies to offset cost of premium to persons who are Medicaid Bound and Tweeners Low.Subsidies represent a cost to the state and are not estimated to receive federal financial participation.

42


To subsidize or not to subsidize, that is the question

2% premium income standard used

43

Major Group MEDICAID

BOUND TWEENERS - LOWTWEENERS -

HIGHFINANCIALLY INDEPENDENT TOTAL

Income Range $0- $24,999 $25,000 - $49,999 $50,000 - $99,999 $100,000 +

Federal CLASS: Subsidize Low Tweeners

Subsidies -$ 109$ -$ -$ 109$

Total Premiums -$ 192$ 192$ -$ 383$

Percent of Premiums 57% 0% 28%

State Contribution Program: Subsidize Medicaid Bound & Tweeners Low

Subsidies - 2% income test 835$ 378$ -$ -$ 1,213$

Total Premiums 1,055$ 1,008$ 1,632$ 1,559$ 5,253$

Percent of Premiums 79% 38% 0% 23%

State Contribution Program: Subsidize Medicaid Bound ONLY

Subsidies - Pay noo more than 3% income test 725$ 63$ -$ -$ 788$

Total Premiums 1,055$ 1,008$ 1,632$ 1,559$ 5,253$


State Contribution Program: No Subsidies

Subsidies -$ -$ -$ -$ -$

Total Premiums -$ -$ 1,632$ 1,559$ 3,191$

Percent of Premiums 0% 0% 0%

Private Insurance - No Subsidies

Subsidies -$ -$ -$ -$ -$

Total Premiums -$ 85$ 85$ 85$ 258$


Note: Dollars expressed in millions.


Tax-i: Will tax incentives take us for a ride?

Tax Incentives Encourage very little participation in private insurance Who benefits from this approach?

Two types considered

#1. Tax deduction. Above-the-line tax deduction for long-term, deducted directly from a taxpayer’s

adjusted gross income (the “line”) Tax deductions based on 5.3% income tax

#2 Tax credit. Tax credit of some specified amount for those with long-term care needs or

their caregivers Assumptions Credit = $500 that reduces price of insurance to the buyer

44


Tax incentives to encourage take-up rates

Illustrates costs based on specific assumptions about “take-up” rates for each program.

TABLE X. TAX CREDITS & TAX DEDUCTIONS

Tax Credit: $500 Tax Deduction

Federal Class 109,434,951$ 17,400,157$ State Contribution Program 2,188,699,013$ 278,402,514$ Partnership LTC Insurance, example 109,434,951$ 7,669,989$

45


#1. Expand access to HCBS

46

Seniors

Adults with disabilities excludes

CommonHealth

CommonHealth only

Average cost HCBS PMPY $13,200 $35,000Waiver service users 10,000 10,000 Total Spending ($ in millions) $132 $350

Low - Risk 25% 25% 25%Base - Risk 50% 50% 50%High - Risk 75% 75% 75%

Low - Risk PMPY $3,300 $8,800 $8,800Base - Risk PMPY $6,600 $17,500 $17,500High - Risk PMPY $13,200 $35,000 $35,000

New users a/ 12,000 207,000 15,000

Low ($ in millions) $40 $1,810 $130Base ($ in millions) $80 $3,630 $260High ($ in millions) $160 $7,260 $530

a/ Excludes Medicaid recipients who are in institutions and current waiver users.Senior expansion includes individuals with self-care needs (2 or more ADLs).


#2. Expand Medicaid eligibility for seniors

47

FPL 100 - 199% 200 - 299% TOTAL

Income up to 21,672$ 32,508$ Total MA population 65+ 224,248 172,499

Estimated number of Seniors, 65+, not currently MassHealth membersPMPY

Nursing Facility $55,602 4,000 3,000 63,000

Community LTC Users: Self-Care Needs $19,182 12,000 12,000 43,000

Community Well: Every Day Task Needs $1,592 43,000 34,000 79,000

Community Well - Acute only $1,592 146,000 119,000 267,000

TOTAL 205,000 168,000 373,000

Estimated total cost to Medicaid for providing care to these groups (in millions)Nursing Facility $218 $168 $385

Community LTC Users: Self-Care Needs $232 $224 $456

Community Well: Every Day Task Needs $68 $54 $123

Community Well - Acute only $233 $189 $422

TOTAL $751 $635 $1,386

Estimated current spending by individuals before spending down income to Medicaid levelsCost to Medicaid ($ millions) $202 $54 $256

BASE CASE - TOTAL COST ($ millions) $954 $688 $1,642

Low cost - 20% reduction $763 $551 $1,314High cost - 20% increase $1,144 $826 $1,970


building a roadmap for financing long- term services & supports melding private insurance, a...

Documents