Performance Improvement 2000. Disability, Aging and Long-Term Care Policy

01/01/2000

A Descriptive Analysis of Patterns of Informal and Formal Caregiving among Privately Insured and Non-Privately Insured Disabled Elders Living in the Community

Long-term care (LTC) expenditures account for almost 12 percent of total personal health expenditures--a threefold increase since 1960--leaving large numbers of elderly Americans vulnerable to catastrophic expenditures that can rapidly deplete their income and life savings. Limited public funding for long-term care expenses, coupled with tax incentives for individuals and companies to obtain private LTC policies, has heated up sales in the burgeoning private long-term care insurance market. This research was designed to answer such questions as: Does private LTC represent a "good buy?" How are benefits being used, and do claimants feel they are getting good value for the premiums they pay?" This research was designed to answer these questions and to provide basic socio-demographic and service utilization profiles for disabled private LTC insurance policyholders, and to compare such data and findings to the experiences of non-insured disabled community-dwelling elders. Finally, a discussion is provided on the implications of such findings on the service delivery system as well as on the design of private and public LTC programs and policies.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Doty, Pamela
202-690-6613

PIC ID: 6399.1

PERFORMER: Lifeplans
Waltham MA

Medicare's Post-Acute Care Benefit: Background, Trends, and Issues to be Faced

A major policy response to the escalation in expenditures for Medicare's post-acute care benefits--from about $2.5 billion in 1986 to more than $30 billion in 1996 caused a change from retrospective cost-based reimbursement to case-mix adjusted prospective payment. Among the concerns is that the impact of these changes on cost, quality, and access is unknown. The impact of these changes on is unknown somehow failed to address many other cost, quality, and access concerns. Foremost among these is the concern that Medicare continues to treat the different types of post-acute care providers differently--in terms of payment, eligibility, coverage, and certification--even though the different types of providers may be becoming more and more similar in the types and intensity of services they deliver, as well as the types of patients they serve. Other concerns include policy-induced incentives to discharge patients for financial rather than quality of care reasons and access problems faced by heavy-care patients. This study examined recent changes in post-acute care payment policy, identified potential problems with Medicare's post-acute care services and explored promising solutions.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Harvell, Jennie
202-690-6613

PIC ID: 7365.1

PERFORMER: Urban Institute
Washington, DC

Preliminary Data from a Survey of Employers Offering Group Long-Term Care Insurance to Their Employees

This interim report provides timely information about current practices in the employer group Long-term care (LTC) insurance market that can inform federal policy makers and employers in deciding how to construct a group LTC insurance offering. It summarizes data collected from a survey of employers offering group long-term care insurance to their employees. The survey is part of a study funded by the Assistant Secretary for Planning and Evaluation (ASPE), Department of Health and Human Services (HHS) investigating current products and best practices in the employer group LTC insurance market. The survey found that among employers offering the product, access to coverage is greater in the employer market than in the individual market. The survey also found that surveyed employers usually limited the number of benefit choices considerably. For example, a majority offered three or fewer benefit amount options. Nearly all employers used a single LTC insurer. The data also suggests that the benefit features of employer group plans generally resemble individually purchased policies. While these findings may be indicative of trends in the employer LTC insurance market, the sample was not large enough to justify a claim that results are representative of all medium and larger employers offering LTC insurance. The final report of the survey's findings can be found in PIC ID #6718.1.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Cutler, John
202-690-6443

PIC ID: 6718

PERFORMER: The Lewin Group
Fairfax, VA

Risk Selection Among SSE Enrollees in TennCare

Risk selection in managed care plans occurs when the healthcare needs of beneficiaries enrolled in a specific plan differ systematically from risk assumption built into the premium calculation methodology. When this occurs, state administrators of Medicaid should adjust payments to managed care plans to ensure that each plan's payment accurately reflects the needs of its enrollees. Without such a payment system, problems for plans and beneficiaries are likely to arise. Plans with adverse selection (that is, a disproportionately large number of high-need beneficiaries) are likely to lack the resources required to deliver adequate care to their enrollees, forcing them, perhaps, eventually, to drop out. Plans with favorable selection (a disproportionately large number of low-need beneficiaries) will be paid more than necessary to provide care. The disability supplement to the existing Health Care Financing Administration (HCFA) evaluation of Medicaid 1115 waiver demonstrations in five states adds a disability focus to the study of the TennCare program in Tennessee. This supplement examined the experiences of disabled adults (physically disabled, mentally ill, mentally retarded, or developmentally disabled) and disabled children enrolled in the TennCare and TennPartners programs. The project conducted: (1) in-depth qualitative analyses of the state's experience in enrolling individuals with disabilities into managed care systems, and (2) quantitative analyses to examine costs and utilization data for these populations. In addition, the supplement conducted a survey of disabled consumers to examine issues of satisfaction, quality, health status and functioning. Findings indicated that risk selection is difficult to prevent or reduce, especially when attempting to maintain continuity of care in the transition to managed care Alternative reimbursement options, however, require the development of good data. See PIC ID 6289, 6289.1, 6166, and 6166.1.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: McKay, Hunter
202-690-6613

PIC ID: 6289.2

PERFORMER: Mathematica Policy Research, Inc.
Plainsboro, NJ

State Welfare-to-Work Policies for People with Disabilities: Changes since Welfare Reform

This report was prepared by The Urban Institute for the Office of the Assistant Secretary of Planning and Evaluation (ASPE). The purpose of this study is to determine the extent to which states have used the flexibility provided under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) to change their welfare-to-work policies as applied to individuals with disabilities and caregivers. This is the first attempt to provide a nationwide overview of welfare- to-work policies for individuals with disabilities and caregivers. Key findings on work participation and time limit policies show that: (1) the majority of states are using the flexibility provided under PRWORA to increase participation in these programs among person with disabilities; (2) states that have 'broadened' participation requirements but have stopped short of requiring 'universal' participation have done so in a variety of ways; (3) states requiring universal participation among welfare clients use individualized service planning strategies that emphasize recipients' capabilities and acknowledge that the path to self-sufficiency may be long; and (4) states are in the early stages of assessing who among those on welfare may need assistance beyond 60 months.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Marton, William
202-690-6613

PIC ID: 7245

PERFORMER: Urban Institute
Washington, DC