How Your State Can Simultaneously Save Medicaid Money and Comply with the ADA

Subject: How Your State Simultaneously Save Medicaid Money and Comply with the ADA

How Your State Simultaneously Save Medicaid Money and Comply with the ADA - Information Bulletin # 175 (9/06)

What an offer! Your State can simultaneously save precious Medicaid funds and comply with the ADA and Olmstead requirements. How? By developing a Money Follows the Person proposal that 'wows' CMS and wins a coveted MFP demonstration grant.

We have heard rumors that some State Medicaid officials have said that MFP will not save funds. NOT TRUE.

Thanks to the National Academy for State Health Policy in Portland, Oregon and Hendrickson Consulting, we now have a "Nursing Home Relocation Impact Calculator" which disability advocates can use to determine exactly how much Medicaid funds your State will save per person IF the your State receives an "enhanced" MFP federal match and IF your State then moves persons out of a nursing facility.

The "Nursing Home Relocation Impact Calculator"shows savings both for those states with "bed taxes" (See Information Bulletin # 172) and those states without bed taxes.

If you want to obtain the "Nursing Home Relocation Impact Calculator,"
because I cannot attach it to the list serve, you must email me and I will send you an individual attachment with the Calculator in an Excel spreadsheet format.

Once you have it, you must obtain and insert some simple information from your State. I do not have this information for your State, so YOU must obtain it. You must know what:

1. your State's Medicaid per day reimbursement for Nursing Facilities;

2. the federal-match % of your State's Medicaid;

3. whether or your State has a "bed tax." If it does have a bed tax, then you keep the 3% on the Calculator, but if you State does not have a bed tax, then delete the 3% and insert 0); and

4. the average annual waiver Medicaid cost per person for community services ("HCBS")(which you can find in the appendix to your State's Waiver application for persons who are either "aged" or "physical disability.")

By inserting those four items in the Calculator's spreadsheet, it will automatically calculate the Medicaid savings your State will achieve.

In the "Nursing Home Relocation Impact Calculator" which we have provided for example purposes only, we have assumed $125 dollars a day Medicaid reimbursement per person for a nursing home, a 57% federal match (i.e., the national average), a 3% "bed tax" (the maximum permitted after the Deficit Reduction Act of 2006), and $20,000 community-based Medicaid expenditures per person, i.e., Home and Community Based Services. Each State will be different. Just take the Calculator's Excel Spreadsheet and insert the correct figures for your State.

In the example, we have two columns, one "without a bed/provider tax"
andone "with a bed/provider tax." In the first box, we look at the "institutional costs" per bed. In our example sheet, with a provider tax, the state pays $18,839 of State funds for each person in a nursing facility.

In the second box, we look at HCBS (community costs). Here, however, we look at the cost in the community b with OR without the MFP "enhanced" match. That is, if the regular Federal match were 57%, then with MFP it increases to 79% and the cost to the State to provide services to that person in the community is reduced in half, i.e, from $8,600 to $4,300.

In the third box ("Differences/Savings with Regular FMAP"), we show the "difference" or SAVINGS to your State, again with and without the "bed tax." The differences are quite stark! The differences represent what the state will save if the person is moved to the community without a MFP.

If your State receives an MFP demonstration grant, then it will save
$15,319 per person by moving the person out of the nursing facility (without a MFP, it would save $11,019). If your State has a bed tax and is lucky enough to be awarded a MFP demonstration grant, it will still save $14,539.

Disability Advocates:
How could your State NOT apply for MFP?
Why would your State NOT want to save Medicaid funds AND stop
"unnecessary institutionalization"?
Didn't the Supreme Court in the Olmstead decision hold that if a State
could end "unnecessary institutionalization" and does not, that
is illegal discrimination under the ADA.

Thanks again to Bob Mollica and Leslie Henrickson.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects.
To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.