Professional Documents
Culture Documents
Hopes and prayers, the general desire to do good without knowing how, seem to us frail reeds on which to lean, though these are the bases on which many programs are begun.
-Pressman and Wildavsky, Implementation, 1984
Recession
Twenty-eight states project that 2012 tax revenues will come in below pre-recession levels Since 2008/09, California has cut $15 Billion from health and human services programs, consequently losing another $15 Billion in matching federal funding
Cuts have included SSI/SSP, Medi-Cal and other health services, Adult Day Health Care, mental health and substance abuse funding, reductions in services for people with developmental disabilities, IHSS, senior services and nutrition programs. Completely de-funded Older Californians Act programs including Alzheimers Day Care Resource Center, Brown Bag, Linkages, Respite Purchase of Services and the Senior Companion program.
According to the California Budget Project, fiscal year 2010-11 General Fund spending in California was lower as a share of the States economy than in 33 of the prior 40 years.
However, the incentives of the ACA combined with state budget distress are driving rapid change. Many states are undergoing or about to undergo a dizzying array of LTSS transformations. -On the Verge report
State Solutions
Managed Long-Term Services and Supports (MLTSS) A plan in which a contractor, a managed care organization, is responsible for providing beneficiaries with a defined set of services in exchange for a pre-paid capitation payment. Includes both skilled nursing and home and community-based services.
12 States already have Medicaid MLTSS programs 11 More States are implementing them in 2012-13 In addition, 28 States are undertaking dual eligible integration projects
Geographic Managed Care: State contracts with several commercial plans in a county
Available in 2 counties, serving 450,000 beneficiaries Steenhausen, 2012
Upcoming Processes:
March 2012 - Announcement of site selections Spring 2012 - Review and approval of CA proposal by CMS Summer 2012 - Development of 3-way financial contracts August/September - 2012 Readiness Review January 2013 - Launch
Medi-Cal HCBS: In-Home Supportive Services (IHSS) Adult Day Health Care/Community-Based Adult Services Medi-Cal HCBS Waivers: Multipurpose Senior Services Program Assisted Living Waiver HCBS Waiver for the Developmentally Disabled Acute Hospital Waiver AIDS Waiver - Steenhausen, 2012
CA now one of only 7 states without state-only LTSS (AK, MS, MO, NH, NM, RI). In 2012, 12 states will increase these programs to help with rebalancing, and 17 will hold their funding steady. Authorization remains for these programs despite their being de-funded.
3) Develop Bridges & Business Models to Contract with Managed Care Plans
States using innovative strategies to maintain these services; one strategy is inclusion in duals integration projects. Another is marketing services to other state agencies. Finally, it is critical to develop business models to contract with private sector partners such as managed care plans.
5) Strengthen the Role of the Older Americans Act in Managed LTSS Through Federal Authorization
OAA due for federal reauthorization. Bernie Sanders (I-VT) introduced S. 2037 in January 2012 to reauthorize. National Council On Aging working on this; could collaborate to strengthen the formal role of OAA programs within emerging dual eligible and other integrated managed LTSS programs.
Discussion Points
Is California moving too fast? Is the State giving adequate time for stakeholder input, preserving current system strengths, and developing good public policy?
Do policy proposals demonstrate knowledge of and take into account the value and needs of family caregivers? Do policymakers need information and education about the role, contribution and health risks of family caregivers?
What are the linkages between the new managed service delivery system and Older Americans Act programs? Are policymakers and managed care plans familiar with Older Californians Act programs that are currently authorized but not funded?
What strategies are necessary to begin collaboration with managed care plans and to develop business models for the aging and disability network to create contracting relationships with plans?
What role do policymakers envision for Aging and Disability Resource Centers in the developing system, and what are the most effective ways to leverage that role so that the aging and disability network makes a strong contribution to the system of care?
Laurel Mildred, MSW Mildred Consulting and Advocacy Policymaking with People in Mind Laurel.Mildred@mildredconsulting.com www.mildredconsulting.com 916-862-4903 @LaurelMildred