Finance and Delivery Reforms for Services for the Frail Elderly
Summary
There is a need for a package of reforms in the financing and delivery of services for the frail elderly to maximize scarce health care and housing resources and to minimize institutional care, similar to the model for service delivery for the special needs of the mentally retarded and developmentally disabled.
Conference Position
The Catholic Conference supports a reformed system of care for the frail elderly characterized by the following:
- An emphasis on home- and community-based services
- Opportunities for consumer choice and the ability to direct one’s own care
- Service eligibility determination that does not require an individual to become impoverished
- The ability of providers to fit services to the individual
- A system of finance and regulation that supports the coordination of care across settings and over time
In order to achieve such a system, the Conference supports the following reform initiatives:
- The Medicaid eligibility level for older disabled individuals, currently 100% of the Federal poverty level, should be increased. This would help disabled elderly individuals access the Medicaid services necessary to keep them at home and out of nursing homes. Alternatively, a higher eligibility threshold could be limited to those who are deemed “nursing home eligible” and/or those enrolled in comprehensive home- and community-based care programs, such as PACE or the Long Term Home Health Care Program.
- Asset and income exclusions under Medicaid for recipients of home- and community–based services should be conformed to the nursing home requirements, which incorporate spousal protection.
- Medicaid should reimburse clinics for the difference between what Medicare pays for physician services and what Medicaid would pay for a person only eligible for Medicaid, in order to facilitate access to primary and other needed medical care.
- Scoring requirements for housing grants should be modified to recognize the special circumstances of the frail elderly. In addition, non-profits that develop assisted living should receive tax credits and full real estate tax exemptions under the Real Property Tax Law.
- Additional assisted living program units should be made available before new nursing home beds are authorized.
- The PACE program should be made a permanent program in New York with broader opportunities for participation.
- A comprehensive Medicare home- and community-based waiver application should be developed similar to that which the state submitted to support the development of an individualized service environment for mentally retarded and developmentally disabled individuals.
Rationale
Currently, the frail elderly receive needed services from a wide variety of programs, principally Medicaid. These programs are often disjointed, conflict with one another, and are less than comprehensive. The current system results in excessive institutionalization and maximally intrusive, high cost interventions. The results are wasteful expenditure of scarce resources and dissatisfaction among program beneficiaries and their families.
The failure of the current system of care places an enormous burden on family caregivers and on an already-overburdened health care system. Significant improvement in the State’s system of services for the frail elderly is not only possible but also affordable. A truly rational system of service for the frail elderly should be minimally intrusive and should maximize opportunities for community living.
You can download this document, Finance and Deliver Reforms for Services for the Frail Elderly, in PDF form.
