Legislative Agenda for the 2014 Session

The Connecticut Association of Area Agencies on Aging (C4A) looks forward to working with members of the Connecticut General Assembly to provide effective and cost-efficient services to Connecticut residents. C4A is an association comprised of five Area Agencies on Aging (AAA) that provide a seamless range of services to Connecticut’s older residentsand individuals of all ages who are eligible for Medicaid and/or Medicare. C4A administers programs and fundsunder the Older Americans Act, Medicaid waiver, State respite care programsand Money Follows the Person (MFP). AAAsplay a major role in helping consumers successfully navigate the complex medical and social service arenas including the coordination of health insurance information; streamlined access toassistance programs; comprehensive assistance to help consumers understand complicated program eligibility and application processes; and long term care supports to meet emergent consumer needs.Area agencies on aging represent the boots on the ground helping to transition hundreds of Connecticut’s residents from institutional settings back to their communities. In this changing healthcare landscape, AAAs stand ready to support the bridge between medical and social services to provide an integrated approach to meeting consumer needs. As the 2014 session approaches, C4A looks forward to discussing issues that affect seniors and other vulnerable populations.

Help Consumers Navigate the Complex Long Term Care Supports System

Full support to provide Information, Referrals and Accessto Connecticut’s older adults, caregivers and persons with disabilities. Connecticut’s citizens need assistance navigating the myriad of home and community-based services. The concept of a single point of entry is essential to help individuals navigate complex eligibility and application processes. Websites do not meet the needs of many low-literacy individualsor individuals without computer proficiency. Information is often presented in legal or medical jargon. The State Innovation Model recognizes the importance of coordinated efforts of community organizations, healthcare providers, employers, consumers and public health entities. C4A stands ready to strengthen community-based health and social services and linkagesto primary healthcare by working to develop uniform, effective processes leading to certification as a community-based practice support entity. By offering a consumer-based model of advocacy, literacy and navigation supports, consumers will make the best long term care decisions and ultimately save State funds.

Support for Fair and Equitable Reimbursement of Community-Based Services

C4A appreciates the demands imposed on the State’s budget as a result of the slow growing economy. A connection must be made between the stabilization of critical programs that constitute the safety net for our most vulnerable citizens and Medicaid rate reimbursement for providers. As members of the General Assembly consider programs and budgetary decisions to address the needs of our most vulnerable citizens, we urge you to be mindful that many providers have gone seven years without a cost of living adjustment while facing significant increases in rent, utilities and insurance expenditures. In 2014, we ask that the Connecticut Legislature supports the full cost of doing business through a much-needed analysis and corresponding increase to the reimbursement rate of Medicaid providers. The State’s Money Follows the Person initiative and Medicaid waiver diversion programs put stress on an already burdened long term care system. Reimbursement rates have been frozen since 2007 resulting in some agencies refusal to accept Medicaid clients. This trend will limit the care plan options for older adults and jeopardize the quality of care for Connecticut’s most vulnerable citizens. To insure an adequate community-based network of long term services and supports the State needs to adequately reimburse providers. Short-term gains reaped from inadequate reimbursement will soon give way to long term loss as clients experience higher hospital recidivism rates, increased emergency department use and declining health outcomes.

Presumptive Eligibility

To support the Governor Malloy’s policy initiative to move from institutional care to community-based care,the Connecticut Association of Area Agencies on Aging (C4A)recommends that “Presumptive Eligibility” be used byConnecticut Access Agencies (AA) when assessing potential clients for the Medicaid Elder Waiver program.

Background

The term “Presumptive Eligibility” means that an elderly applicant is temporarily accepted for Medicaid and can receive services through the Waiver program following an initial screening by the appropriate AA. If the applicant meets the basic functional and financial eligibility criteria, the applicant can immediately begin receiving in-home services, case management and other benefits through Medicaid Waiver. AAs woulddetermine presumptive eligibility through statements from the applicant and a functional assessment.

The applicant must still be approved by the Department of Social Services, but the application process would not delay the applicant receiving services. This change would increase the number of diversions and the federal dollars coming into Connecticut.The formal Medicaid application process can begin immediately following the Presumptive Eligibility action, but waiting on Medicaid approval would not delay the diversion process. It is the responsibility of the AA to monitor the application process and set a deadline for the submission of all associated documentation. Failure to submit the required application documents would result in immediate termination of services and the applicant would be held responsible for the expenditures to date. If the applicant is not approved at this point, past expenditures may be paid through State funds or, in the case of false statements, from the applicant.

Connecticut has established Presumptive Eligibility for pregnant women in low-income families. The policy grants immediate, temporary health coverage through Medicaid to women meeting the basic eligibility guidelines.The goal was to quickly start prenatal care and reduce infant mortality by funding services during the waiting period for final approval.

Advantages

In this situation, applicants are frail elderly adults who face the risk of nursing home placement because they are not able to provide self-care. If institutionalized, they are at risk of losing their homes in the community and face increased impairment with longer recovery times.

Presumptive eligibility has been used for a number of years in other states, such as Ohio, Pennsylvania, Washington, and Iowa.

The advantages are:

  • More Federal money is pulled into the state through Medicaid.
  • The case is expedited with the client receiving services more quickly.
  • There is less risk of premature nursing home placement due to faster provision of in-home services.
  • Applications are done more thoroughly with low error rates (less than 2% in other states).
  • Fewer State Alzheimer’s Respite funds and Older Americans Act funds would be used to support the clients pending eligibility resulting in a greater number of non-waiver qualifying clients served.

Issues

There is the possibility that an applicant could be determined to be eligible by the initial assessment and later found to ineligible by the state because ofclient misrepresentation or other errors in the initial assessment. Funds expended during the time between the initial assessment and the state’s approval process would need to be paid through Medicaid Waiver Administration funds. While this is a concern, historically there is a very low error rate (fewer than 2%) for the initial screening and there would not be a large amount of Administrative funds required.

Current Action Needed

C4A believes that Presumptive Eligibility should become accepted procedure within the Medicaid Elder Waiver application process immediately. This process has been supported for pregnant low-income women and has been used successfully in several states in the past five years. C4A asks the legislators to consider this important legislation in keeping with the critical needs of constituents and Connecticut’s desire to rebalance Medicaid expenditures.

For further information on programs and services offered through the Connecticut Association of Area Agencies on Aging:

Contact:Marie Allen, Executive Director

Telephone:203-333-9288

Email:

Web site:

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