Division of Aging Releases 1493 Report on Home and Community Based Services 10/3/2017

1. Evaluation of the current system of services;
2. Study of functional and financial eligibility process;
3. Identification of options for services and supports that are cost effective, high quality, and focus on social and health outcomes;
4. Evaluation of reimbursement rates including rate methodology; and
5. Review of potential migration of individuals from one waiver to another or one service from another should that be necessary.

The report discusses demographic trends, costs to the state for providing HCBS and nursing facility services, and ultimately provides 24 suggested action steps on how to grow HBCS in Indiana.  As with any program to grow HCBS, an underlying goal is to reduce reliance on nursing facility care as the default method for providing long term services and supports to Indiana’s Medicaid population.

To do this, a lot of reliance is being place on how to connect family caregivers and beneficiaries to existing and potentially new programs in order to delay or prevent nursing facility admissions.  Importantly, the report appears to set a goal of providing equal volume of services between HCBS and nursing facility services, rather than trying to equalize spending between the two segments of service delivery.  This likely sets a more reasonable goal to achieve.

The issuance of the 1493 Report is another step, though a significant one, to renew the discussion on how to mitigate significant future cost to the Medicaid program and provide services to Hoosiers in the least restrictive setting possible.  The Division of Aging has made clear, however, that nursing facility services are integral to the overall system and to the needs of Hoosiers.  Balancing consumers’ preferences for location/mode of services and the fiscal pressure on state and federal governments to afford those services are the paramount weights in this dialogue of redesigning long-term services and supports.