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State Takes Important First Step to Enhance Choice in Long-term Care

July 2008

An AARP study proves what we have long known; older Ohioans overwhelmingly want to "age in place" in their own homes. Ninety-three percent of those who answered the survey consider it important for them and their families to have choices regarding types of long-term care services, and 94 percent want services that would enable them to stay at home as long as possible.

Today, Ohio depends on nursing homes for nearly 70 percent of our long-term care. But it doesn't have to be that way. While nursing facilities are critically important for those who need that level of care, many more of us could stay in our own homes and communities with some supports and services.

Governor Strickland and the Ohio General Assembly support providing low-income Medicaid consumers with a choice of long-term care services. This means offering an array of services that meet consumers' needs throughout their lives. This is especially important as the baby boomers age and place increasing demands on the long-term care system, at the very time our resources are stretched to the limit.

Currently, 24 percent of Ohio's General Revenue Fund budget is spent on Medicaid, the major funding source for long-term services and supports. A recent report from the Scripps Gerontology Center at Miami University estimates that the number of Ohioans of all ages which will need long-term services will increase by 14 percent between now and 2020 - an increase of 43,600 consumers. If nothing changes by then, Ohio will spend 55 percent of its entire budget on Medicaid.

Clearly, this is unsustainable for Ohio to continue to meet this growing burden on our tax base.

To achieve more consumer choice and better balance within our long-term care system, the Ohio Department of Aging convened a workgroup of consumers, providers, advocates, policymakers and others to create a unified long-term care budgeting process that would provide consumers with access to a full array of services. This process also will provide Ohioans with a system that is cost-effective, reduces duplication and results in more satisfied consumers and families.

On May 30, 2008, the workgroup submitted its recommendations to the Governor, the leaders of the General Assembly and the members of the Joint Legislative Committee on Medicaid Technology and Reform.

The workgroup and its five subcommittees, including more than 300 individuals, developed over 100 recommendations, beginning with the recommendation that we include all consumers who have a chronic or recurring need for services, regardless of age, and that the plan be implemented in four phases:

• Phase One covers the Medicaid-eligible population that needs a high degree of assistance either because of their age or due to a physical disability.
• Phase Two will include Ohioans who need long-term services and supports, due to behavioral health needs such as mental illness or drug and alcohol addiction.
• Phase Three will be developed around consumers who historically receive services through the Mental Retardation and Developmental Disability system.
• Phase Four will include long-term services to consumers who do not meet Medicaid eligibility guidelines.

The workgroup also believes that wherever you go in your community - the area agency on aging, the mental retardation or mental health board, or the local department of job and family services - you should be able to get the help you need. And you should be able to access that help in person, on the phone or over the internet.

The full report is available for download online at www.goldenbuckeye.com/ultcb/. The Unified Long-term Care Budget is an ongoing process and I look forward to providing you with more information on the subject as it develops.

Barbara E. Riley