June 11, 2009

Creating the Analytic Framework for Home and Community-Based Services

Susan Reinhard, RN, PhD, FAAN, who is senior vice president and director at the AARP Public Policy Institute, was the keynote presenter at The Hilltop Institute Symposium on Thursday, June 11, 2009. Dr. Reinhard "constructed a framework for exploring both the current state of the evidence regarding rebalancing initiatives and the development of a new analytic framework to advance an evidence-based research agenda."

"Dr. Reinhard presented data from a variety of sources to demonstrate that the percentage of Medicaid long-term care spending going to HCBS from 1995 to 2007 increased 1 percent to 2 percent per year, with 39 percent of long-term care dollars going toward HCBS for all Medicaid beneficiaries. The percentage of Medicaid long-term care spending going to HCBS for the Mentally Retarded/Developmentally Disabled (MR/DD) population increased 33 percentage points over the 12-year span, whereas HCBS spending for older adults and adults with physical disabilities increased by 15 percentage points over the same time span. Dr. Reinhard pointed out that current trends in balancing mean that we will achieve a 50/50 spending balance in 2019."

"Dr. Reinhard presented data on balancing efforts in various states. The national average for the percentage of Medicaid long-term care spending for older people and adults with physical disabilities going to HCBS in 2007 was 27 percent, not taking into account statefunded HCBS programs. Comparatively, New Mexico spent 61 percent, Oregon spent 56 percent, Washington spent 55 percent, Rhode Island spent 11 percent, Utah spent 5 percent, and Tennessee spent only 1 percent of its Medicaid long-term care dollars on HCBS. Dr. Reinhard cited that, in 2007, nearly one-half of all states spent less than one in five Medicaid long-term care dollars for older people and adults with physical disabilities on HCBS, with only eight states spending more than two in five Medicaid dollars."

"The data and analysis suggest that a richer dialogue is needed in examining the role of evidence in supporting HCBS and balancing. Dr. Reinhard maintained the need for stakeholders to present evidence and create dialogue." [Excerpted from The Symposium Proceedings.]

For more information on the Hilltop Institute visit: www.hilltopinstitute.org