Indiana Medicaid 5-8 Year Long Term Care Plan

IHCA, HOPE and LeadingAge met with FSSA and OMPP on February 3rd to re-start discussions on the 5-8 year long term care plan that FSSA Secretary John Wernert challenged the industry to help develop.  Medicaid Director Joe Moser made it very clear that he is concerned with the imbalance that Indiana has with respect to spending on institutional services versus home and community based services when compared to other states.  Though Director Moser has stated to IHCA in the past that a transition to more HCBS does not have to be driven by budgets, Director Moser explained his concern by comparing spending on institutional services versus home HCBS.  He presented the following numbers on annual per patient spending:

Service Type	SFY 2014 Spend Per Patient
Nursing Facility	$48,756
AL Waiver	$36,000*
Home Care	$16,950

*Approx. number (AL Waiver only is $14,968, but this does not include other state plan services and needs to before it is a reasonable comparison)

These numbers reflect all that are eligible for NF care and, except for AL Waiver, reflect both waiver and state plan services.

In addition, Director Moser presented data on the percentage spend, and not persons served, on NF and HCBS.  The data he presented is below:

SFY 2014		SFY 2013		SFY 2012		SFY 2011		SFY 2010
NF Spend	HCBS Spend	NF Spend	HCBS Spend	NF Spend	HCBS Spend	NF Spend	HCBS Spend	NF Spend	HCBS Spend
75.4%	24.6%	78.4%	21.6%	78.6%	21.4%	79.1%	20.9%	79%	21%

Director Moser made it clear that his goal is to change these percentages so that the NF percentage decreases and the HCBS percentage increases.  Director Moser also made it clear that he wants the participation of the nursing facility profession to help make this happen, rather than the agency going it alone on a top-down approach.  He wishes to develop benchmarks through the planning process, with incentives and penalties, that both the industry and the State will be held to.

The next steps will include the formation of 4 work groups that will feed into the overall planning process. The groups are:

1. Reimbursement – Will examine other state approaches, including managed care (Sec’y Wernert specifically states that managed care needs to be examined and that some in the industry are in favor of managed care)
2. Entry Point – Will examine the ways in which beneficiaries enter the post-acute system and how they are routed to particular services, and then how to change those patterns to ensure right place, right time, least restrictive/costly setting
3. Housing – Will examine challenges to housing for Medicaid beneficiaries
4. Assisted Living – Will examine other state’s approaches to using AL as an alternative to nursing facilities and how Indiana’s structure for waivers and state plan services may need to change to encourage more AL utilization in the Medicaid program

OMPP will put more details together about these workgroups and the overall planning process.  IHCA will reach out to members to find members with specific knowledge and time to participate in these work groups.

If you have any questions, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001