Feds Approve Vermont Program Giving Medicaid Recipients Alternatives to Nursing Home Care

If they possibly can, most people who require long-term care would prefer to receive services in their own homes instead of a nursing home. However, many people are forced to enter a nursing home if they wish to receive Medicaid coverage. A new state/federal program in Vermont is trying to end this "institutional bias" in Medicaid.

The U. S. Department of Health and Human Services (HHS) has granted Vermont's request for a waiver of current Medicaid rules so that it can set up the Vermont Long Term Care Plan. This five-year demonstration program establishes a unique triage system to evaluate the appropriate type of care for Medicaid enrollees who may be at risk of institutionalization.

Under the plan, which officials hope to have under way by September 1, each beneficiary will be assessed based on eligibility criteria. Those who fall into the highest tier of need will be offered a choice between a traditional nursing facility or whatever expanded services are needed to keep them in their own homes. Those in the second tier, requiring fewer or less intensive services, could still receive nursing home or home-based care, but will be served in the order of greatest need. The second-tier beneficiaries will continue to receive acute care and other supportive services. A third tier will expand community-based services to 950 older and disabled individuals who are at risk of institutionalization but who would not yet qualify for services without the demonstration.

Between 85 percent and 95 percent of people currently eligible for nursing homes in Vermont will become part of the new entitlement group, said Patrick Flood, commissioner of the Vermont's Department of Aging and Independent Living.

"This program will provide important evidence on how to end the institutional bias in Medicaid, to allow people with a disability to live in the community when they prefer to do so, without increasing Medicaid costs." said Mark B. McClellan, M.D., Ph.D., administrator of the Centers for Medicare & Medicaid Services, which administers the Medicaid program at the federal level.

The program is intended to be budget-neutral. Flood said that by giving Medicaid recipients equal access to services, "more people will stay at home, we'll save money, and that will permit us to serve even more people than we otherwise could. That's a very simple concept that could really work anywhere."

For the HHS press release on the Vermont program, go to: https://www.hhs.gov/news/press/2005pres/20050613.html

For a United Press International article on the program, click here.