States are struggling to meet requirements for long-term care and support services for elderly and disabled adults, even as more states are increasing participation in home- and community-based health services (HCBS), according to a report released in July.
The report was issued jointly by AARP Public Policy Institute, the National Association of States United for Aging and Disabilities and Health Management Associates. Furthermore, demand is growing for non-Medicaid services even though many states are maintaining current funding levels or reducing them.
The report identified a disturbing trend among the long-term services in demand. Between 2010 and 2012, more than 60% of responding states have seen an increase in demand for adult protective services. However, expenditures on these services remain largely unchanged, and some states reported a decrease.
Furthermore, according to AARP, there's no current source of federal funding to support APS programs. Passed in 2010 as part of the Affordable Care Act, the Elder Justice Act authorizes federal funding for APS programs, but Congress has yet to act. "Due to their heavy reliance on state funds, APS programs exhibit particular sensitivity to economic downturns and declines in state revenues," the report noted.
The report, "At the Crossroads," was conducted last fall among state aging and disability agencies and Medicaid agencies. The report includes responses from 48 Medicaid agencies, including Washington, D.C. (North Carolina, South Dakota and Wisconsin did not participate), and 48 aging and disability agencies (Florida, West Virginia and Wisconsin did not participate).
[Check out Top 10 Cheapest States for Long-Term Care Costs: 2013 at ThinkAdvisor]
Although some state's fiscal conditions have improved since 2007, the study found recovery was "inconsistent." Most states said they expect their 2013 tax revenue to exceed their pre-recession level, but 16 states expect revenues will remain below their pre-recession level.
"The recession affected states at different times, and to different degrees," according to the report. "The impact of the economic decline in any single state would be cumulative over time and would depend not only on the magnitude of revenue decline from pre-recession levels, but also on the length of time the state experienced such a decline."
Medicaid is the largest funder of long-term aging and disability services, the report found, with a combined state and federal total of $131 billion in 2011. While 7% of Medicaid recipients are receiving benefits for long-term care services, they account for 30% of expenditures.
