Texas: Promoting Independence –Promoting Choice

Marc S. Gold

Texas Department of Aging and Disability Services

Washington, DC

November 7, 2008

National Health Policy Forum

Texas Demographics

Total population: 22,968,24865-74 years: 1,412,053 (6 %)75+ years: 1,098,001 (5%)

Texas 65+: 2,510,054 (11%)US 65+: 13 percent

*Urban Institute/Kaiser Commission: U.S. Census Bureau’s March 2006-2007 current population survey

Long Term Services Budget (08)

Overall State: $85.7 billion All FundsHealth/HumanServices: $28 billion All Funds –

@33 percent of state

DADS: $5.7 billion All FundsManaged Care: $1.2 billion All Funds –

@25 percent of HHS

All Medicaid: @45 percent of AF

Aged/Blind/ 27 percent caseloadDisabled: 61 percent expenses

Long Term Services Clients (08)Institutional

Nursing Facility-Related: 69,959 (24%)ICF/MR-Related: 11,888 (3%)TOTAL: 81,847 (27%)

Community-basedNF-Related: 165,314 (53%)ICF/MR-Related: 29,359 (9%)Managed Care: 33,325 (11%)TOTAL: 227,998 (73%)

GRAND TOTAL: 309,845

Promoting Independence History

1980- Personal Care1985- first 1915 (c) waiver for IDD population1991- implementation of 1929 (b) attendant program1994 - CBAJune 1999: Olmstead DecisionSeptember 1999: Governor George W. Bush’sExecutive Order GWB 99-2 (1999)June 2001: Senate Bill 367 and Rider 37 (MoneyFollows the Person)Governor Rick Perry’s Executive Order RP-13June 2005: House Bill 18672007: CMS’ MFP Demonstration

Interest List – June 30, 2008

CBA: 29,316STAR+: 2,916ICM: 263All waivers: 82,050 (unduplicated)

Average Length on Interest List:CBA: 0.7 years

DADS Website: Interest Lists – www.dads.state.tx.us

Money Follows the Person

Created as an appropriation rider tothe then DHS (DADS) Budget as Rider37 (2001)

Movement directly into 1915 (c)waiver

“Slots” did not count against appropriated “slots”

MFP Statistics

As of August 31, 2008:

@ 16,306 individuals have transitionedfrom Texas Medicaid-certified nursingfacilities

@ 7,190 individuals remain active in the community

MFP Demographics

43 percent are 0-64

57 percent are 65+ (27 percent are85+)

49 percent relocate with their family; 25 percent alone; 23 percent intoassisted living; 3 percent into a group home

Relocation Supports

Complex NeedsRelocation ActivityTransition to Life in the Community/Transition AssistanceServicesCommunity Transition TeamsHousing Voucher Program

Community vs. Institutional Cost

Average Monthly Cost per IndividualServices for Money Follows thePerson: $1419/month (1915 {c} waiver]

Net Nursing Facility Cost perMedicaid Resident per Month: $2797

*These figures are derived from the TX Department of Aging and Disability Services’ Legislative Appropriations Request for Fiscal Years 2010-2011

Barriers to Relocation

HousingCo-occurring behavioral healthissuesLack of provider base to serveindividuals with complex needsStabilized direct services workforceRural areasTransportationSufficient funding for relocationactivityHealth and welfare concerns

Future Initiatives

Managed CareCMS MFP Rebalancing DemonstrationAging and Disability ResourceCenters (“one-stop shopping”)Institutional diversionProviding community opportunities forchildren aging out of their programsAddressing children currentlyresiding in institutional settingsSpecialized 1915 (c) waivers

CMS MFP Demonstration

Deficit Reduction Act of 2005: Section 6071 – MFP Rebalancing Demonstration

5 year Demonstration

$1.75 Billion

Impacts individuals residing in nursing facilities, community ICFs/MR, and state schools

CMS MFP Demonstration

Texas will receive $20 million in enhanced funding: project overall will expend @200 million in All Funds. A total of 2,999 individuals will be part of the Demonstration.Texas Demonstration

Nursing Facility and ICF/MR residentsBehavioral Health projectOvernight Support ServicesVoluntary closure of 9+ bed community ICFs/MRPost-relocation contactsHousing

Contact Information

Texas Department of Aging and Disability Serviceswww.dads.state.tx.us

Marc S. GoldDirector, Promoting Independence Initiative512.438.2260marc.gold@dads.state.tx.uswww.dads.state.tx.us/business/pi/index.html