Medicaid Long Term Services and Supports

NASW-Michigan Statement on the 2020 Proposed MDHHS Budget

The annual budget for the Michigan Department of Health & Human Services (MDHHS) determines funding levels for programs and services that impact the ability of older adults and disabled persons in Michigan to live safely, be healthy and self-determining. The state of Michigan’s aging population is growing significantly, with the number of Michigan citizens over the age of 85 projected to triple by 2045.  Recent reports indicate that Michigan now ranks 29^th across the states in the proportion of Medicaid Long Term Services and Supports (LTSS) funds going to Home and Community Based Services (HCBS). It would serve the citizens of Michigan, and be cost effective for the State to continue to expand effective Home and Community Based Services.

Michigan residents eligible for Medicaid receive long term services and supports (LTSS) through five major Medicaid programs. Michigan’s LTSS Programs are: Home Help, the largest of these programs (54% of MLTSS enrollments), is the personal care state plan benefit; Skilled nursing facilities (nursing homes) (29%); MI-Choice (12%) provides home and community based services to individuals who require a nursing facility level of care; MI Health Link (3%) is available to individuals with both Medicare and Medicaid coverage; and PACE (2%) also serves individuals with both Medicare and Medicaid Michigan administers these five programs with a mix of managed care and fee-for-service arrangements. Home Help and nursing facilities are reimbursed on a fee-for-service basis.  MI-Choice, PACE and MI Health Link are funded through managed care arrangements.

Effective use of long-term services and supports (LTSS) for older adults and disabled person show positive results in increasing access to home and community based services that allow individuals to live in their homes and communities rather than nursing homes, and that reduce preventable hospitalizations and emergency department episodes. It is important that Michigan citizens have access to the appropriate level of care and service modality for their individual need. Needs change as the aging and/or chronic disease processes progress, therefore it is important that a range and continuum of services exists. Wasted taxpayer dollars and avoidable human suffering result from lack of access to appropriate services.

MI-Choice and PACE are two programs that have demonstrated cost effectiveness, while improving consumers’ quality of life.

We agree with the House Health and Human Services Appropriations Subcommittee which included in their budget a 5% increase in funding for MI Choice in the FY 2020 budget. NASW-MI joins other organizations and coalitions in recognizing the priority that should be given to expanding MI-Choice Medicaid Waiver services that provide access to home and community-based services that allow someone who otherwise would be in a nursing home to remain safely in their own home. Increasing access to MI-Choice is building upon a proven winning strategy. The overwhelming majority of Michigan residents prefer to “age in place” in their own homes and communities. This program saves taxpayer dollars by allowing a greater share of people needing services to remain in their homes. Medicaid dollars can support nearly three older adults or persons with disabilities in home based services for every one person in a nursing home.

NASW-MI also supports continued support and expansion of the Program for All-Inclusive Care for the Elderly (PACE), a program available in multiple parts of the state. This program is praised by most stakeholder groups as a model for integrated care that successfully addresses many of the issues raised by providers and consumers, according to a recent report commissioned by MDHHS.

Both MI-Choice and PACE are in fact funded with managed care funding models.

MI Health Link was piloted in Michigan in recent years as a possible platform to integrate Managed Long Term Services and Supports for people with both Medicare and Medicaid. We are not a proponent of expanding or extending MI Health Link. The unimpressive results to date and absence of data necessary to ascertain the program’s success or inform decisions regarding the future of the MI Health Link approach from the pilot programs in multiple locations around the state, provide no basis for supporting any expansion of this pilot, if it is even continued at all. There are serious questions and no tangible data to demonstrate that health plan management of long term services and supports either reduces costs or improves quality of care. 

Three key features are paramount to better serve the citizens of the State of Michigan:

•  A comprehensive, integrated continuum of support, services, settings and delivery models to meet each individual’s and family’s biopsychosocial needs related to aging, chronic impairment, functional limitations, and caregiving
• Coordinated assessment, service planning and service delivery by well-trained interdisciplinary teams, with particular attention given to client transitions between LTSS service providers and settings
• Collaboration with clients in all aspects of LTSS planning and provision to maximize dignity and self-determination

In summary, long term services and supports (LTSS) help individuals with disabilities and older adults to maximize their independence and quality of life. These services build upon community, individual and family strengths. The number of Michigan citizens relying on LTSS will continue to grow dramatically as the number of citizens aging and living with chronic diseases continues to increase.  MI-Choice and PACE are two LTSS programs offered in Michigan that coordinate, improve access to services, enhance quality, and increase participant and family involvement and satisfaction. Further, these home and community based approaches support the self-determination of participants and families, differing from the deficit-focused medical model that does not. Both MI-Choice and PACE are proven and successful programs currently funded with a managed care arrangement, and we encourage the expansion of funding for both of these effective programs.