Citation URL: http://www.urban.org/JessicaKasten

While data limitations from the Medicare Current Beneficiary Survey make direct comparisons between HMOs and traditional Medicare spending misleading, it is still important to examine the out of pocket spending in HMOs. This paper looked at patient characteristics including health status, age and income differences in out of pocket costs. Just as with the traditional Medicare program, out of pocket costs are considerably higher for those in poor or fair health. Thus, even though costs for beneficiaries are likely to be lower overall, the same types of patterns with sicker beneficiaries paying more occur. Another finding was that while HMOs offer drug coverage, beneficiaries still pay a considerable amount out of pocket. (Published by The Commonwealth Fund; 2000 July.)

The need for long-term care assistance affects people of all ages, not just elderly populations. Accordingly, this chart book provides relevant information on long-term care assistance for all people with disabilities, using a variety of state and federal data sources. Using this chart book, policymakers, researchers, advocates, and practitioners will be able to understand the scope of the long-term care system. Information is organized into three major categories: consumers, providers, and financing.

Maryland, a fairly small mid-Atlantic state with about 5 million people in 1999, has 12 home and community services programs for older persons and adults with physical disabilities. Maryland’s Medicaid program provided home and community services to approximately 5,100 beneficiaries through the optional personal care benefit and 4,600 beneficiaries through its optional medical day care program in fiscal year 1999. The state has one currently operating Medicaid waiver for older adults with 135 slots, which will be expanded to 1,135 slots in 2001. The state will implement another waiver in 2001 with 150 slots in the first year for non-elderly adults with physical disabilities. The state also has eight small, state-funded home and community services programs designed to serve adults who are not eligible for Medicaid. The state has a complex administrative structure for its home and community services programs, with several state and local agencies involved.

Michigan, a large mid-western state with 9.8 million people in 1999, provided home and community services to about 46,600 beneficiaries through its optional personal care benefit and 14,400 people through its Medicaid waiver during state fiscal year 2000. Michigan dramatically increased the number of Medicaid home and community-based services waiver slots from 4,000 in state fiscal year 1998 to 15,000 in state fiscal year 2000, an increase designed to expand home and community services options for people with disabilities. Despite the size of Michigan’s home and community services programs, nursing homes still dominate the state's long-term care system. In 2001, Michigan began implementing long-term care reforms designed to move away from discrete public programs to a coordinated, comprehensive system.

This Congressional Research Service report analyzes state strategies for containing long-term care costs for older people. To improve finance and delivery systems, states are expanding home and community-based services and are integrating acute and long-term care services through the use of managed care. Secondly, states are seeking to substitute private, Medicaid, and Medicare financing for state funding through tax incentives, private long-term care insurance, and establishing public/private partnership. None of these strategies has contributed much to containing long-term care costs. If faced with an economic downturn, count on states to rely on traditional strategies--such as cutting reimbursement rates and controlling nursing home supply--which run counter to the demographic imperative of the aging baby boom generation.

This Congressional Research Service report analyzes state strategies for containing long-term care costs for older people. To improve finance and delivery systems, states are expanding home and community-based services and are integrating acute and long-term care services through the use of managed care. States are also seeking to substitute private, Medicaid, and Medicare financing for state funding through tax incentives, private long-term care insurance, and establishing public/private partnership. None of these strategies has contributed much to containing long-term care costs. If faced with an economic downturn, count on states to rely on traditional strategies - such as cutting reimbursement rates and controlling nursing home supply - which run counter to the demographic imperative of the aging baby boom generation. Congressional Research Service Report for Congress; May 2000. Available at http://www.urban.org/UploadedPDF/1000056.pdf.

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