Ray's Round Up: Proposed Changes to Long Term Services and Supports

As Labor Day Weekend approaches, things are slowing down in the Capital. One meeting that took place before the holiday weekend centered around long-term services and supports (LTSS). Many people only think of nursing home care when they hear the term long-term services and supports, but home health care, family caregiving, adult day services, home modifications, and a host of other community-based services are all a part of this system.

Governor Tom Wolf’s Administration has proposed a significant change in how Pennsylvania funds LTSS. Before describing this change, it’s important to give a quick description of how the state currently gets involved in helping individuals in need of LTSS.

There are two sources of funding for LTSS in the Commonwealth. The first is the Pennsylvania Lottery. Lottery revenues support a number of LTS programs for older Pennsylvanians which are designed to help individuals remain in their homes and communities. Eligibility for these programs is based on income, but there is no asset test required.

The second is the Medicaid program. Medicaid is jointly funded by the Federal and State governments and is limited to individuals with minimal incomes who have exhausted their assets – but Medicaid LTSS coverage is not limited to older individuals. Importantly, coverage of nursing home costs for individuals who qualify financially is an entitlement – in other words no one who meets the health care and income qualifications for nursing home care can be denied coverage. There are also a number of other forms of LTSS, such as home health care, which can be covered by Medicaid, but each state must apply for a “waiver” of regular Medicaid rules in order for these services to be covered.

The change that Governor Wolf has proposed is to shift Pennsylvania’s method of administering the Medicaid Long-Term Services and Supports program to a managed care model. What this would mean is that instead of the state government administering the program, the state government would hire private insurers to administer the program.

As always with issues of this type, the true impact of this change is contained deep in the details of any proposal that may be advanced. For instance, would managed care organizations allow their LTSS consumers to choose their own doctors and specialists? Would managed care organizations do a better job in promoting home and community based services? How would managed care organizations handle the different needs of older consumer and disabled consumers?

This week the Department of Human Services and the Department of Aging convened a new workgroup of consumers and stakeholders that are concerned with how managed long-term care might be introduced in Pennsylvania. One of the appointees to this workgroup is Stella Hyde, former AARP Pennsylvania Volunteer State President who is currently a member of the Pennsylvania Council on Aging. Hyde is a strong consumer advocate whose views will carry a great deal of weight in the deliberations of this workgroup. The workgroup will be tasked with reviewing the Administration’s proposals and ensuring that the interests of the consumers of LTSS are recognized. It is likely this will be a process that continues throughout the rest of 2015.

In the end, any change to Pennsylvania’s long-term services and supports system should be about saving state dollars and improving the system for consumers. Advocates for older Pennsylvanians, including AARP, will continue to emphasize that point...perhaps after legislators return to the Capitol after Labor Day weekend festivities, including the annual Kipona Festival held on the banks of the Susquehanna River. Fun fact: Kipona is a Native American term that means “to be on the sparkling water."

 

“Ray’s Round Up” features updates on current state and federal issues by Ray Landis, AARP PA’s Advocacy Manager.