Home and Community-Based Services for Older People and Younger Adults with Physical Disabilities in Michigan

HOME AND COMMUNITY-BASEDSERVICES FOR OLDER PEOPLE ANDYOUNGER ADULTS WITH PHYSICALDISABILITIES IN MICHIGANFinal ReportPrepared for:U.S. Department of Health and Human ServicesHealth Care Financing AdministrationPrepared by:Jane Tilly and Jessica KastenThe Urban InstituteThe Lewin GroupFebruary 26, 2001 HOME AND COMMUNITY-BASEDSERVICES FOR OLDER PEOPLE ANDYOUNGER ADULTS WITH PHYSICALDISABILITIES IN MICHIGANFinal ReportPrepared for:U.S. Department of Health and Human ServicesHealth Care Financing AdministrationPrepared by:Jane Tilly and Jessica KastenThe Urban InstituteThe Lewin GroupFebruary 26, 2001 262035This research was supported by Health Care Financing AdministrationContract No. 500-96-0005. In this contract, the Urban Institute is asubcontractor to the Lewin Group. The opinions expressed in the report arethose of the authors and do not necessarily reflect the position of the HealthCare Financing Administration or the Urban Institute. Final Report262035Table of ContentsINTRODUCTION.............................................................................................................1THE LONG-TERM CARE SYSTEM IN MICHIGAN................................................1PROGRAMS AND ADMINISTRATIVE STRUCTURE.............................................3ELIGIBILITY CRITERIA AND ASSESSMENT.........................................................5CARE MANAGEMENT AND SERVICE PLANNING...............................................7SERVICES.........................................................................................................................8CONSUMER DIRECTION.............................................................................................9COST CONTAINMENT................................................................................................10QUALITY ASSURANCE...............................................................................................12FEDERALISM ISSUES.................................................................................................14ISSUES FOR THE FUTURE.........................................................................................15 Final Report1262035INTRODUCTIONMichigan, a large mid-western state with 9.8 million people in 19991, provided home andcommunity services to about 46,600 beneficiaries through its optional personal care benefit and14,400 people through its Medicaid waiver during state fiscal year 2000. Michigan dramaticallyincreased the number of Medicaid home and community-based services waiver slots from 4,000in state fiscal year 1998 to 15,000 in state fiscal year 2000, an increase designed to expand homeand community services options for people with disabilities. Despite the size of Michigan’shome and community services programs, nursing homes still dominate the state's long-term caresystem. In 2001, Michigan began implementing long-term care reforms designed to move awayfrom discrete public programs to a coordinated, comprehensive system.This paper outlines the home and community services system for older people andyounger adults with physical disabilities in Michigan, focusing on the state administrativestructure, eligibility and assessment, services covered by Medicaid and other programs, costcontainment, and quality assurance. This report also summarizes government officials’ and keystakeholders’ opinions about how well the Medicaid and state-funded programs work.Information was obtained from public documents, state of Michigan web sites, andinterviews with nine state officials and key stakeholders including four consumer representatives,and six waiver agents and provider representatives. Interviews were conducted in person inLansing, Michigan during March 2000. One telephone interview was conducted in the samemonth. Questions were asked using a structured, open-ended interview protocol. To encouragecandor in their answers, respondents were told that they would not be quoted by name oridentified by type of respondent within a state (e.g. nursing home industry representative inMichigan).THE LONG-TERM CARE SYSTEM IN MICHIGANMichigan has a lower-than-average supply of nursing home beds and a substantialnumber of home health agencies. The state had 459 nursing facilities with 51,966 beds in 1 http://www.census.gov Final Report22620351998—42.5 beds per 1,000 persons age 65 and over, compared with a national average of 52.5.2According to the Health Care Association of Michigan, the nursing home census has remained atapproximately 50,000 residents for the last 20 years. Department of Community Health figuresshow that the nursing home occupancy rate decreased slightly from 95 percent in 1996 to 9