By Herb Weiss
Published in Pawtucket Times, October 25, 2013
A warm, nutritious meal combined with social interaction can go a long way to putting the brakes to a state’s spiraling Medicaid costs. According to new study findings detailed in this months issue of Health Affairs by Brown University public health researchers, expanding programs like Meals on Wheels, would save 26 of 48 states money in their Medicaid programs, just by allowing a person to stay in their own homes.
Kali Thomas, Assistant Professor of Research in the Brown University School of Public Health, says that if every U.S. state in the lower 48 expanded the number of seniors receiving meals by just 1 percent, 1,722 more Medicaid recipients avoid living in a nursing facility and most states would experience a net annual savings from implementing the expansion.
Put the Brakes to Medicaid Costs
According to the study’s findings, Medicaid cost savings would be different in every state. For instance, Pennsylvania would see the greatest net savings – $5.7 million – as Medicaid costs for nursing facility care decrease more than costs rose for delivering the additional meals. Meanwhile, Florida would see a net cost of nearly $11.5 million instead. Overall, 26 states would stand to see a net savings according to the Brown University Public Health analysis, while 22 would end up spending more.
Every state would enable more seniors, who could live independently except for meals, to remain in their homes regardless of whether they are on Medicaid.
Thomas, the study’s lead author, believes the study’s findings can provide guidance for state lawmakers and state policymakers as they hammer out budget funding for home-delivered meals programs, which are conducted under the Older Americans Act.
“We wanted to provide a roadmap for people,” Thomas said.
To calculate Medicaid savings, Thomas and co-author Vincent Mor, Brown’s Florence Pirce Grant Professor of Community Health, examined data, including how many seniors in each state receive home-delivered meals and how much it costs each state to provide those meals. She and Mor also took a look at nursing facility and Medicaid data to estimate the number of seniors that Medicaid maintains in nursing facilities who are “low-care,” meaning they may have the functional capabilities to live at home. Finally they looked at the per diem Medicaid pays in each state for seniors to live in nursing facilities.
Keeping Seniors at Home
The study findings allowed them to estimate the incremental cost of providing meals to 1 percent more seniors in each state, the number of additional seniors on Medicaid who would no longer need to live in nursing facilities, and how much less Medicaid would have to pick up for the higher level of care in each state.
The researchers found that the 1 percent expansion nationwide would bring meals to 392,594 more seniors at a cost of more than $117 million. Because 1,722 seniors would no longer have to live in costly nursing facilities paid for by Medicaid, total program savings would total $109 million.
The reason why the study’s findings indicate that additional food delivery costs outstrip Medicaid savings nationwide, even though most states would save money on a net basis, is that in some very large states with relatively few low-care seniors or relatively low Medicaid per diems, food costs outweighed the resulting Medicaid savings on a relatively large scale.
“In states like California and Florida where a 1-percent increase in the 65-plus population is a lot of people, it will cost those states a lot more to feed them,” Thomas said.
But, as she and Mor wrote in Health Affairs, “Our analyses suggest that 26 states with high Medicaid nursing home per diem reimbursement rates, a large proportion of low-care [nursing home residents on Medicaid], and a relatively small population of older adults, could save money.”
Thomas said states projected to lose money can opt to focus their efforts in ways that are more precise than an across-the-board expansion.
“We’re not proposing that all states simply increase the proportion of age 65 plus receiving meals by 1 percent,” she said. “But if they were to target these vulnerable people who are at risk for nursing home placement they would likely see more savings. This is a program that has the potential to save states a lot of money if it’s done correctly.”
Policymakers should consider not only the fiscal implications of providing home-delivered meals, which the study quantifies, but also the impact on individual seniors, said Thomas, who has seen the benefits anecdotally as a Meals on Wheels volunteer in both Florida and Rhode Island.
Thomas’s research, detailed in this month’s issue of Health Affairs, which was completed last December, is featured in AARP Rhode Island’s award-winning documentary Hungry in the West End. Creator and director John Martin of the AARP
Rhode Island state office screened the documentary in August at the Meals on Wheels Association of America National Conference in Boston. You can watch Hungry in the West End online at www.aarp.org/hungry.
Although the quality of life argument is easy to see, other researchers, like Thomas, are closely looking at how the Meals on Wheels program can lower Medicaid costs.
Based on a study by the Washington, D.C. based Center for Effective Government released in April 2013, every dollar invested in Meals on Wheels today could save taxpayers up to $50 in Medicaid costs down the road.
Other Benefits of Meals on Wheels
Ellie Hollander, President and CEO of the Meals on Wheels Association of America, observes that both Brown University and the Center for Effective Government studies specifically focused on Medicaid savings attributable to nursing homes, but do not take into consideration significant savings that would be realized through reduced Medicare costs as well, through fewer visits to physicians and the emergency room and less hospitalization or reduced readmissions.
Hollander says, “We have long known that the value of Meals on Wheels goes beyond the social and moral imperative of helping to address the epidemic of senior hunger in America. “The friendly visit and a safety check are a lifeline enabling seniors to live more independently and healthy in their own homes, which in turn avoids far more costly health care alternatives often paid through Medicare and Medicaid,” she says.
“The Brown University research proves what our work has long suggested to us: the Home Delivered Meals Program not only makes a positive impact for the senior, it is a good investment for the state as well,” says Executive Director Heather Amaral, Meals on Wheels of RI.
Another study is in the works to support Thomas’ efforts to closely look at the impact of nutritious home delivered meals. According to Hollander, a $350,000 grant from the AARP Foundation and the Meals on Wheels Association announced on Oct. 6 will enable Thomas to begin her randomized controlled trial of 600 seniors representing a cross-section of rural, urban, low income and minority populations across the country and a majority of the grant will be used to feed these seniors.
In this upcoming study, 200 seniors will receive meals daily, 200 more will receive a delivery of frozen meals once a week and then another 200 will continue on the waiting list as before as a control group. The study will compare quality of life, isolation, and health care utilization among individuals before and after they begin receiving meals and across the three groups.
Holland says, “Through our generous grant from AARP Foundation, and with Dr. Thomas and Brown University’s help, we will seek to monetize the value add of the “more than a meal” component of Meals on Wheels.”
A Call for Support
On AARP.org, Kathleen S. Connell, Rhode Island AARP State Director, calls on state lawmakers to take a very hard look at how they fund the state’s Meals on Wheels program. Connell urges Congress not to put the Meals on Wheels program on the budgetary chopping block as a way to chop the huge federal budget deficit.
Connell says that “Leaders need to be reminded that Meals on Wheels recipients aren’t unemployed workers waiting to return to jobs that will accompany an economic recovery. They are older retirees living on limited fixed incomes. With the cost of prescription medicines, healthcare and utilities going up, they sometimes can’t afford to eat. Many commonly sacrifice on food because of money worries – real or feared.”
Connell notes, “Meals on Wheels is a big deal [to seniors]. No one should take it for granted.”
Herb Weiss, LRI ’12, is a writer covering aging, health care and medical issues. He can be reached at firstname.lastname@example.org
Photo: Brown University