Weekly Update - December 12, 2011

The Commonwealth is committed to providing citizens with open and transparent government. Last year the legislature passed and the governor signed into law new transparency and accountability reforms as part of the FY 2011 Budget. As part of this proactive approach to civic engagement, the Executive Office of Administration & Finance, the Office of the Treasurer and the Office of the Comptroller have been working jointly on the Open Checkbook Website.  

Testimony on the FY 2013 State BudgetAl Norman from Mass Home Care shared his budget testimony.  Here is the introduction that is the most comprehensive statement I've seen to justify my title above.

Before the Executive Office of Health and Human Services

December 2 and December 9, 2011

Presented by Mass Home Care

Over the past decade, Massachusetts has seen a remarkable drop in the use of nursing facilities. In FY 2011, MassHealth paid for nearly 3.7 million fewer nursing home patient days paid than in 2001. The gross savings to the taxpayer were $592 million in 2011.

This happened by design, not by accident. Elder and disability rights activists have pushed hard to expand community based long term supports and services (LTSS). Despite our success in taming the nursing facility "budget buster," we have had many setbacks and false starts along the way:

• In September 2005, Massachusetts was awarded a 5-year Systems Transformation grant from the federal government. The goal was to transform the state's long-term support system for elders and people with disabilities in Quality Management, nursing facility diversion and Long-term Supports with housing. But very little transformation actually took place.
• In August of 2006, the equal choice law guaranteed adults on MassHealth a choice of care in "the least restrictive setting appropriate to their needs." But today, the MassHealth state plan and regulations only guarantees nursing facility care. If you want 24/7 supports at home, or in a community group home, you will have a very hard time.
• On July 1, 2008, the 1115 waiver was supposed to begin, promising expanded home and community based services. After two years of state planning, a waiver was submitted to the federal government---but ultimately it was abandoned.
• In September of 2008, the Governor's Olmstead Plan was released, with the mission of creating a "community first" long-term care policy," and "the deliberate development of more accessible and effective long-term supports in local communities." The Olmstead Plan promised to shift the "focus of long-term care financing from institutions to the community." But today, 64% of our Medicaid long term care spending still goes to institutions, and only 36% to community first care.
• In January of 2008, the Commonwealth blocked Medicaid funding for small group homes for the elderly, stopping one of the more promising community delivery systems. This option is not even part of the 1915c Medicaid waiver for the elderly. People with a brain injury or a developmental disability can get into small group home. But not if you are a disabled senior.
• In 2009 and 2010 advocates fought to get $2.5 million in state funds released for the Equal Choice "Options Counseling" that manages the front door of nursing facilities, to inform people of their options in the community before they decide on a nursing facility. This program is woefully underfunded, as is the program that funds diversion efforts targeted to people already in nursing facilities.
• Two months ago a national report from AARP said that Massachusetts ranked 40th in the nation for Medicaid LTSS users first receiving services in the community. According to this report, if Massachusetts improved its performance to the level of the highest-performing state,10,203 more new users of Medicaid LTSS would first receive services in home and community based settings instead of nursing homes;3,945 nursing home residents with low care needs would instead be able to receive LTSS in the community.
• In 2011, the Money Follows the Person grant reported that MassHealth LTSS spending in FY 2009 in the community was 34.3% of total spending. LTSS spending by MassHealth for institutions, at 65.7%, is still the dominant form of spending. If the two sectors were rebalanced to have a 50/50 share of funding, community based care would see a gain of $337.5 million. If the percentage share of LTSS expenditures were reversed to give community care a 65.7% share of funding, community care would receive $674.6 million in additional funds. If Massachusetts rebalanced its MassHealth spending to match Oregon's 55% share for community care, the elderly and disabled spending in the community would rise by $444.8 million.
• In 2011, the state submitted a grant for federal funding that would turn over total control of LTSS for people on MassHealth to large hospital and physician networks-despite the fact that these managed care entities have no experience in managing LTSS, and if anything have demonstrated an institutional bias in their referral patterns