FISCAL NOTE



FUND(S):

0403 Div of Human Services Gen Admin 8722 Cons Fed Funds Div Human Services

Sources of Revenue:

General Fund,Other Fund X-Federal

Legislation creates:

A New Program



Fiscal Note Summary


Effect this measure will have on costs and revenues of state government.


The purpose of the bill is to create a long-term care system that supports community based services, patient centered care, establishes a voucher program for consumers to use for their care in the most flexible environment possible; to establish an appeal process; to establish rule-making authority and to establish reporting requirements. It is anticipated that this legislation would significantly increase Medicaid costs and potentially expand Medicaid eligibility. As written, the Department of Health and Human Resources (Department) is unable to calculate a fiscal impact of implementing this legislation. (See MEMORANDUM SECTION).



Fiscal Note Detail


Effect of Proposal Fiscal Year
2009
Increase/Decrease
(use"-")
2010
Increase/Decrease
(use"-")
Fiscal Year
(Upon Full
Implementation)
1. Estmated Total Cost 0 0 0
Personal Services 0 0 0
Current Expenses 0 0 0
Repairs and Alterations 0 0 0
Assets 0 0 0
Other 0 0 0
2. Estimated Total Revenues 0 0 0


Explanation of above estimates (including long-range effect):






Memorandum


Home/Community based services are currently available under the existing Aged/Disabled (A/D) Waiver and MR/DD Waiver programs (which are subject to slot allotment approval by CMS); this bill does not specify what additional services would be necessary. The "Consumer" definition specifies only one ADL which is a lower standard than those currently required for nursing home, ICF/MR or either of the waiver programs. This would expand Medicaid eligibility (for those existing programs and this new program) and render the programs ineligible for the enhanced federal Stimulus funding. There is no means by which to estimate the population that would be eligible for these services. During SFY 2008 approximately 74% of nursing home residents indicated a desire to return home however the bill does not speak to medical criteria applicable for this determination to receive these services, and many members in congregate settings may no longer have a home to which to return if they were discharged. The bill does not address funding for those types of costs, which cannot be paid for through Medicaid. The bill requires consumer direction, which is currently available under the A/D Waiver program. The "voucher program" and calculation of the 90% requirement is open to variable interpretation, and the bill does not address what would happen when the consumer exceeds their allotted funding for a given year. For SFY 2008 the average annual nursing home cost was $38,153 and ICF/MR cost was $103,180. Congregate settings provide access to things such as durable medical equipment, 24 hour care, and other items not readily available in a home or community setting, which would have to be provided. A/D Waiver, Home Health and Personal Care services may approximate the types of services that nursing home residents may need if discharged to the home or community, and for SFY 2008 the average cost of those combined services was $25,686; this does not include any nursing care which many in that population would need, and is available in a nursing home through RN's, LPN's, and CNA's. Per the 6/30/08 nursing home cost reports CNA's hourly cost is $14.71 per hour, equating to $128,860 per year for 24-hour per day, 7-day a week care such as would be available in a nursing home. Therefore even a minimal amount of nursing care, combined with the A/D Waiver, Home Health and Personal Care services would exceed the cost of nursing home care. Many of the ICF/MR residents discharged to home or community settings would likely require one to one care; SFY 2008 costs for comparable services under the MR/DD program indicate that such care can range from $175,000 to $200,000 or more per year; again this is in excess of the cost of providing these services in the congregate setting. However, without additional stipulations for what services would be allowable under the program created by this bill it is impossible to calculate an accurate cost. Regarding funding, there is currently no dedicated line item for long term care to redistribute to these services as required in this bill; the additional funding mechanisms identified are outside of Medicaid authority to control. Additionally there already exist appeal mechanisms within Medicaid, and the level of personal direction included in this bill may limit Medicaid's ability to remedy any dissatisfaction the member has with their services. Additional information and details are available upon request, please contact Neva Maynor at 304-347-4808.



    Person submitting Fiscal Note: Martha Yeager Walker
    Email Address: dhhrbudgetoffice@wv.gov