Online Program

Implications of Rhode Island's global consumer choice compact Medicaid waiver for rebalancing long-term care under the affordable care act

Tuesday, November 5, 2013 : 8:30 a.m. - 8:42 a.m.

Edward Miller, Ph.D., M.P.A., Department of Gerontology, University of Massachusetts Boston, Boston, MA
Divya Samuel, A.B., School of Nursing, University of Pennsylvania, Philadelphia, PA
Susan Allen, Ph.D., Health Services, Policy, and Practice, Brown University, Providence, RI
Amal Trivedi, M.D., MPH, Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI
Vincent Mor, PhD, Center for Gerontology & Health Care Research, Brown University, Providence, RI
Federal approval of the Global Waiver (GW) in 2009 provided Rhode Island (RI) with greater flexibility to modify its Medicaid program. Because 89% of long-term care (LTC) expenditures in RI are directed toward institutional settings, a primary goal was to facilitate the state's efforts to shift the locus of LTC to non-institutional settings. This study draws lessons from RI's experience with the GW for the LTC rebalancing provisions of the Affordable Care Act (ACA). Data derive from 325 archival sources and 26 semi-structured interviews. Results suggest that prospectively documenting home- and community-based services (HCBS) capacity is necessary to ensure that sufficient resources are available to meet the complex care needs of a larger service clientele. Results also suggest that increased reimbursement is especially important for attracting participating providers; so too is maintaining sufficient numbers of state regulators for purposes of monitoring quality. Ultimately, the distribution of LTC spending is likely to remain stagnant given just how difficult it is for laggard states such as RI to make more than marginal progress even with the provision of additional options and incentives that otherwise should promote rebalancing. Nursing home care continues to be a mandatory benefit while HCBS remains an optional benefit states may offer at their discretion. This leaves investments in HCBS especially vulnerable to the vagaries of state budget and political processes, which when combined with the absence of minimum standards and requirements to cover all geographic areas and target populations, suggest persistent unmet need, both within and across states.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Program planning
Provision of health care to the public
Public health or related public policy
Public health or related research
Social and behavioral sciences

Learning Objectives:
List the main provisions of the Patient Protection and Affordable Care Act intended to rebalance long-term care away from institutions toward home- and community-based services. Identify factors that will promote or impede state long-term care rebalancing efforts under the Patient Protection and Affordable Care Act. Formulate strategies for improving the success of federal and state efforts to rebalance long-term care.

Keyword(s): Long-Term Care, Community-Based Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the lead investigator on a Robert Wood Johnson Foundation grant analyzing health care reform in Rhode Island, in addition to multiple other projects focusing on long-term care service delivery and policymaking, including the implications of the Patient Protection and Affordable Care Act. My primary interests include understanding the determinants and effects of federal and state health policies impacting vulnerable populations, including the frail and disabled elderly.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.