Long Long Term Care Term Care Problems, Problems, Policies Policies and Prosp and Prospects: ects: Stat State e Perspective Perspective Beyond the ACA: Health Policy and Sustainable Health Spending Washington, D.C. July 18, 2017 Hemi Tewarson Director, Health Division NGA Center for Best Practices
About NGA About NGA Conference of Governors The White House, 1908 Na National G tional Gover ernor nors s As Associa sociation tion 2
Health Divis Health Division ion Guiding Principles Guiding Principles The Health Division grounds all of its work in the following guiding principles: • Helping Governors Succeed : Harnessing unbiased expertise to surface and disseminate the most promising evidence-based practices that can assist governors as they strive to improve the lives of their residents • Moving Beyond Theory : Moving beyond theory by breaking down complex challenges and translating best practices into actionable steps governors can take to effectively and efficiently solve problems and create change • Breaking Down Silos : Leveraging expertise across the NGA Center to help governors and their state leaders break down silos and develop integrated, innovative, whole-person solutions that are sustainable over time National G Na tional Gover ernor nors s As Associa sociation tion 3
Health Health Div Division Focus ision Focus Are Areas as Health Systems Transformation Behavioral Health and Social Medicaid and Health Determinants of Insurance Health Data and Analytics Workforce Public Health National G Na tional Gover ernor nors s As Associa sociation tion 4
Governor Governors are s are Activ Activated on Health Reform ated on Health Reform “It is critical that any changes to Medicaid and the private health insurance market reflect states’ experience as major health care purchasers, regulators and administrators who will be responsible for carrying out new reforms.” - 2017 NGA LETTER TO CONGRESS National G Na tional Gover ernor nors s As Associa sociation tion 5
Stated Path for Health Care Reform Manager’s CBO Score AHCA Passes CBO Score of Updated version of AHCA Updated CBO Score Additional BCRA Released Released Amendments House BCRA Released BCRA released Introduced Released Amendments by Senate (3/13) (3/20) (5/4) (6/26) (7/13) (3/6) (3/22) (3/23) 6/22 Phase 1: Repeal and Replace Through Reconciliation HHS 1332 HHS/CMS Letter to Medicaid Letter Governors to Governors (3/14) (3/14) Phase 2: Administrative Actions Phase 3: Other Legislative Action National G Na tional Gover ernor nors s As Associa sociation tion 6
Governors’ Bipartisan Health Reform Learning Network • Provides unbiased information VT* WA ME MT ND about health reform proposals and NH MN* the state impact MA OR NY WI ID SD* MI RI CT WY PA* • Offers a forum for states to engage NJ IA NE OH DE* in dialogue with other state leaders IN IL NV UT* WV VA* and identify shared priorities for CO DC KS MO KY CA reform NC TN SC OK AR AZ NM • Released in June, Shared Priorities GA AL MS from the Governors’ Bipartisan LA TX Health Reform Learning Network AK FL highlights priorities for Medicaid, HI private health insurance and public health *Seven states are also participating in the MCH and Public Health Working Group Na National G tional Gover ernor nors s As Associa sociation tion
Focus on C Focus on Cost Drivers ost Drivers • Pending federal health reform proposals have increased states’ focus on addressing significant cost drivers in Medicaid, including LTSS • Medicaid spending on LTSS was $152 billion in FY2014; 32% of total program expenditures • Despite significant progress in many states to rebalance from institutional to home and community-based services (HCBS), costs for LTSS populations remain high • In addition to continued rebalancing efforts, states are exploring additional options to improve care and control costs for LTSS, including: o Innovative delivery models o Managed care (MLTSS) o Targeted solutions for unique populations (Duals, DD/ID, “at - risk,” etc.) o Caregiver supports National G Na tional Gover ernor nors s As Associa sociation tion 8
Bipartisan Health Bipart isan Health Reform Lear Reform Learning ning Network: Prio Network: Priorities rities for for LTS LTSS Ad Addit itional onal flexibilit ibility y and suppor port t for effor orts ts to imp mprove e qua quality ty and value ue of LTSS Contin inued ed federal suppor port t and investmen estment for states es to mainta tain in and build d on paymen ent t and deliv ivery y reforms ms Flexibi ibility ty to cover er eviden ence ce-based ased services ces that imp mprove e health th outcom comes es and provide de ROI by addres essi sing ng social ial det etermi minan ants ts of health National G Na tional Gover ernor nors s As Associa sociation tion 9
State State Exam Example: ple: Washingto Washington n Recently approved 1115 Waiver established a new, limited LTSS benefit package for two key populations: 1. Medicaid Alternative Care (MAC) : alternative limited LTSS benefit package (those selecting this package forgo traditional LTSS services) • Eligibility: Age 55+; Medicaid eligible (targeting those not currently using LTSS) • Designed to support unpaid caregivers in continuing to provide quality care and delaying the need for more intensive LTSS • Beneficiaries may switch to the traditional LTSS benefit at any time 2. Tailored Services for Older Adults (TSOA): new eligibility group with access to limited LTSS benefit package only • Eligibility: Age 55+; do not currently meet Medicaid financial eligibility (may have assets up to S51,000) • Designed to support individuals who need LTSS and are at risk of spending down to Medicaid Benefits Costs Expected Enrollment and Savings • Caregiver Assistance Services • • $550 PMPM, compared State expects approximately 8,000 • Caregiver Training and Education with full benefit costs of initial enrollment, with a majority in • Specialized Medical Equipment & Supplies $5,200 PMPM for nursing TSOA • Health Maintenance & Therapies • home, $2,000 PMPM for State legislature estimated up to $23 • Personal Assistance Services (TSOA only) home care million in annual savings by year 4 National G Na tional Gover ernor nors s As Associa sociation tion 10
State Example: Virginia State Example: Virginia Virginia is implementing a statewide Medicaid MLTSS program for over 213,000 individuals Statewide in 6 regions Commonwealth Coordinated Care Required enrollment Plus (CCC Plus) Duals/non-duals, children/adults, NF and 5 HCBS waivers Health plans may vary by region Coordination of Medicare benefits through companion D-SNP Continuity of care period is 90 days Builds on Virginia’s Financial Alignment Demonstration, Commonwealth Coordinated Care (CCC) Na National G tional Gover ernor nors s As Associa sociation tion 11
Questions? Hemi Tewarson Director, Health Division NGA Center for Best Practices htewarson@nga.org 202-624-7803 Na National G tional Gover ernor nors s As Associa sociation tion 12
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