Experimental Medicaid Program Keeps More Seniors in Community-Based Settings

In an effort to save $47 million this year, Tennessee’s Medicaid program, TennCare, has established a new program to decrease the number of unnecessary stays in nursing homes by creating a new category of low-income seniors who require some assistance, but not enough to warrant nursing home care, a Washington Post article reported. 

This marks the second initiative since 2009 that the program, which serves 23,705 elderly people, has established to curb the use of nursing homes,says the article. TennCare will pay up to $15,000 each year for seniors in the newly established category, but some consumer advocates believe the funding is inadequate and will leave seniors without services they need.

The Washington Post reports:

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In 2009, the state obtained permission from the federal government to offer nursing home patients—and new long-term care enrollees—the option of receiving care in a family- or community-based setting.

That change has been successful. In 2010, about 83 percent of Tennessee’s long-term Medicaid patients were in nursing homes, with 17 percent in home and community settings under a prior waiver. Today, 66 percent of patients are in nursing homes and 34 percent are receiving home- and community-based services.

Under the new regulations, the previous requirement—that someone need help with an “activity of daily living,” such as dressing or using the bathroom—has been replaced by a complicated weighted point system that makes it considerably more difficult for patients to reach the standard to qualify for nursing home care.

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The focus of this endeavor, said TennCare Assistant Commissioner Patti Killingsworth, is to make sure healthier patients who had, under the old system, qualified for nursing facilities are served “more appropriately” in community-based settings. “We want nursing homes to target patients who truly need their services,” she said.

[Gordon] Bonnyman, the consumer advocate, said TennCare has not done the analysis to warrant that assertion. “On paper, what they’re talking about looks fine,” he said. But “all of this starts with a mandate designed to save $47 million.”

Read the full article here

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Written by Erin Hegarty