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Written by: John Wolf on Monday, December 13, 2010 Posted in:

Stateline today highlights the notable progress that Pennsylvania (a Harmony for Aging customer) is making to help improve the lives of seniors by increasing home- and community-based (HCBS) options in “Stitching Medicare and Medicaid together”.  Facing significant challenges when he took the job two years ago, Michael Hall, Secretary of the Pennsylvania Department of Aging has made great strides in bettering the quality of care for seniors by rebalancing the ratio of money budgeted for HCBS vs. institutional care.  Hall is continuing his work to narrow that gap by combining eligibility rules for Medicaid and Medicare – expanding access to those who qualify as “dual-eligibles”.  His work shows a lot of progress for the seniors in Pennsylvania and is a solid example for other states to emulate.  Included below are excerpts from this story that we believe are worth reading:

Pennsylvania ranked 49th in the nation in offering long-term care alternatives for elders who wanted to avoid nursing facilities when Michael Hall became Pennsylvania’s secretary of aging in 2008.

“Every survey ever done showed that nine out of 10 people in Pennsylvania said they didn’t want to go to a nursing home,” Hall recalls. “But we were spending nine out of 10 dollars on nursing homes, and nine out of 10 people who needed long term care were living in them. We were doing exactly the opposite of what taxpayers and voters said they wanted.”

In just a few years, Hall has made a lot of progress.  The portion of long-term care dollars that Pennsylvania spends on institutional care has dropped from 92 percent to 76 percent. That was the result of many small steps the state has made to better coordinate care for frail elders and to help them find home- and community-based care options rather than automatically steering them toward nursing homes.

Pennsylvania still has a lot of room for improvement, however. On average, states spend just 43 percent of their long-term care dollars on nursing homes. That continuing gap spurred Hall to address one of the toughest and costliest health care challenges, not just in Pennsylvania, but in all states: the problem of how to care for the so-called “dual eligibles.” Those are the people who are both impoverished enough to qualify for the state Medicaid program, as well as old enough or disabled enough to qualify for the federal Medicare program.

Dual-eligibles are so costly to care for because many live alone, have multiple chronic illnesses and are likely to need help with daily activities of living. Among this population, there is a higher-than-normal rate of depression, mental illness, cognitive impairment and drug and alcohol abuse.

Second only to Florida in the percentage of people aged 65 or older, Pennsylvania has an estimated dual-eligible population of 370,000. The state also has the nation’s highest percentage of elderly and disabled people already enrolled in Medicare managed care plans, indicating consumer willingness to participate in an option that would coordinate Medicaid care, as well.

Although it had lukewarm public support, Hall drafted a federal waiver application and planned to move forward with his plan. It was set to go live last July, but creating an IT system that combined the separate and often conflicting eligibility rules for Medicare and Medicaid proved more difficult than expected. The program is now on hold.

In the meantime, Pennsylvania is seeing improvement on nursing home utilization simply by offering traditional fee-for-service Medicaid services along with a managed Medicare plan. One of the largest such experiments in the nation is run by Gateway Health Plan, which serves more than 26,000 patients — about 7 percent of Pennsylvania’s dual-eligible population.

“Our responsibility at the end of the day is changing their quality of life and the trajectory of their lives,” Hall says. “We’re looking at anything we can do to achieve that.”

Learn more about how Pennsylvania is tackling this problem and working to offer better care for dual-eligibles by reading the full story in Stateline here.