State Progress since Olmstead Decision

The following is an excerpt from Steve Gold's Information Bulletins. For more on those bulletins, go to the link below.

Progress Since Olmstead - How Is Your State Doing?

Information Bulletin # 231 (12/07).

In 1999, the U.S. Supreme Court held in the Olmstead decision that "unjustified isolation is properly regarded as discrimination based on disability." The U.S. Attorney General concluded, as the Court noted, that unnecessary "retention of persons in institutions, severely limited their exposure to the outside community [and] constitutes a form of discrimination."

The Court wrote that "institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life." In the decision, the Court noted that a State's efforts should "not be controlled by the State's endeavors to keep its institutions fully populated."

So how much progress has been made in your state between the 1999 Olmstead decision and FY 2006 (the last year for which we have data) regarding people in nursing homes?

Here is what we found using Medicaid's long-term care expenditures in both 1999 and 2006 for the nursing facility institution versus the comparable Medicaid LTC community services - those Medicaid waivers for persons eligible for nursing facilities (i.e., waivers CMS classified only for aged, aged/disabled, and physically disabled), the personal care option, and home health expenditures.

1999 - Olmstead decision - the benchmark:

Nationally 80.4% of the relevant Medicaid's long-term care institutional expenditures went to nursing facilities;

13 states spent more than 90% of their Medicaid LTC expenditures institutionally on nursing facilities (D.C, HI, IL, IN, LA, MS, NH, ND, PA, RI, SD, TN, and UT) and therefore less than 10% in the community;

Only 4 states spent less than 70% on nursing facilities (AR, NC, OR, WA); and

The median state expenditure to nursing facilities was 84.7%. Median means half the states spent more and half less on nursing facilities.

FY 2006 - Seven years later - how much progress has been made:

Nationally, 71.4% of Medicaid's long-term care institutional expenditures went to nursing facilities. That's a "drop" of 9 percentage points from 1999 to 2006, i.e., national Medicaid institutional

expenditures for nursing homes were reduced 9 percentage points from 80.4% in 1999 to 71.4% in 2006, and therefore nationally the states spent this additional 9 percentage in the community and

The median state expenditure to nursing facilities was 78.8% - reduction of approximately only 6 percentage points from 1999.

First the worst states in 2006:

5 states were still spending more than 90% of their LTC on nursing facilities (IN, MS, ND, TN and UT), even though the national average was reduced to 71.4% in 2006, and

7 states had INCREASED the percentage they spent on institutional nursing facilities in 2006 from1999, i.e., they spent a larger percent of Medicaid's LTC expenditures on nursing homes in 2006 than they did in 1999 (AL, AR, DE, KY, MS, SC, and WV).

And now, the best states in 2006:

7 states spent less than 60% of their Medicaid LTC on nursing homes (the national average was 71.4%)(AK, CA, ID, NC, OR, TX and WA), therefore spent more than 40% in the community; and

9 states had a "drop" of more than 15 percentage points from 1999 to 2006 in institutional/nursing facility expenditures. (AK. AZ, CA, DC, ID, MN, NM, TX, WA) and therefor spent it in community.

So what's up with the rest of the States:

16 states had a "drop" of less than 5 percentage points from 1999 (AL, CN, FL, GA, IN, MD, MI, MN, NH, NJ, ND, RI, TN, UT, WI and WY).