Governor Dannel P. Malloy, joined by Department of Social Services Commissioner Roderick L. Bremby today announced the release of the Strategic Plan to Rebalance Long-Term Services and Supports, a town-by-town projection of Connecticut's long-term care needs and strategies to meet those needs. The Governor also announced that up to $72.8 million in federal funding will be awarded to support the expansion of homecare services for seniors and adults with disabilities. The federal funding, combined with a $13 million state investment, marks the first step in a rebalancing plan to expand long-term care services and reduce spending on costly institutional care. It will also help the nursing home industry adapt to the changing needs of elders and other adults with disabilities.
"Planning for our future includes making strategic decisions to ensure that the health services people need are available," said Governor Malloy. "We have to find cost-effective ways of providing high-quality care in people's homes -- it improves quality of life and reduces expenses for consumers and government."
Coordinated by the Department of Social Services (DSS), the "Strategic Plan to Rebalance Long-Term Services and Supports" represents over a year's work by consumers, advocates, home care and other service providers, the nursing home industry, and the state. It uses census and demographic data to develop town-by-town projections for long-term care needs. The analysis will help focus services in specific areas, enlist local planning, and help nursing home operators adapt to meeting anticipated demand.
"Consumers deserve more choices and options for quality long-term care services and supports," said Commissioner Bremby. "At the same time, government must ensure we are using taxpayer dollars in the best way possible. The strategic rebalancing plan and investments are a way to guide and accelerate this process of change for everyone's benefit -- better, more individualized care that is less costly."
The Strategic Plan to Rebalance Long-Term Services and Supports includes:
connecting the public to information about long-term care services and supports;
increasing the number of transitions of long-term nursing home residents to the community;
closing service gaps, improving existing services, and identifying new services;
ensuring quality of care;
building capacity in the community workforce to sustain rebalancing goals;
focusing on housing and transportation supports; and
helping transform nursing facilities into community-based continuing care providers serving a range of needs.
State, Federal Investments to Increase Consumer Choice
Recognizing the need to shift away from institutional care, Governor Malloy and the legislature added $10 million in bond funding and $3 million in general fund support to the state budget this fiscal year to help nursing facilities "right-size" by diversifying care models, downsizing, and modernizing.
The intent is to implement a strategic, coordinated approach to reducing beds where projections indicate that they will not be needed, and ensuring nursing facilities diversify their services to reflect the home care trends. A request for proposals to help nursing facilities "rightsize" by diversifying their business models is under development and will be released in the coming weeks.
Up to $72.8 million in additional Medicaid reimbursement was approved by the federal Centers for Medicare & Medicaid Services (CMS) under the State Balancing Incentives Payment Program. Connecticut will receive an enhanced match rate of 2 percent for non-institutional long-term services and supports funded under Medicaid from this month through September 2015, which boosts the federal reimbursement rate to 52 percent in this area.
"The Balancing Incentive Program provides a strong financial incentive to stimulate greater access to non-institutionally based long-term services and supports," said CMS official Barbara C. Edwards in the funding award letter. "[This] reflects Congress' recognition of the demographic and fiscal imperatives to reshape our long-term care system to meet the needs of our beneficiaries and assure the future viability of the system."
"This funding will be an important component of the state's rebalancing agenda, including transitioning over 1,400 individuals to date from institutional settings to the community," said Kate McEvoy, DSS Interim Health Services Director. "Connecticut is also working with and providing funding to nursing facilities to help them diversify their services; a major workforce development effort; and engaging in a public education campaign."
Medicaid and nursing home trends
Connecticut's Medicaid spending remains weighted toward institutional settings. In fiscal year 2012, 56 percent of long-term care clients were living in the community, but their costs represented only 41 percent of all long-term service expenditures. That ratio has improved markedly over the years, but more expensive institutional care is consuming the majority of long-term care spending for a minority of clients -- only 7 percent of the overall Medicaid-eligible population received long-term care services and supports in fiscal 2012, but took up 47 percent, or nearly $2.8 billion, of the total Medicaid expenditures.
While Medicaid continues to fund more than $1.6 billion in institutional care in Connecticut, over the past decade the number of nursing facilities is declining due to lower census -- a total of 31 skilled nursing facilities have closed since 2001. For those who do not require nursing home care, focusing resources on community care through rebalancing is critical to improving quality of life and containing costs.
The Plan to Rebalance Long-Term Services and Supports Strategies was released at a meeting with the Department of Social Services, nursing home administrators, home care service providers, and other stakeholders.