Financing Long-Term Services and Supports for Individuals with Disabilities and Older Adults Workshop Summary (2014) / Chapter Skim
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4 The Role of Government
4 The Role of Government
Pages 27-40
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From page 27... ...
• A social insurance program could gain political support if it was self-financed, reduced Medicaid spending, and complemented private insurance. (Goldberg)
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From page 28... ...
PUBLIC INCOME SUPPORT PROGRAMS FOR WORKING-AGE PEOPLE WITH DISABILITIES David Stapleton Mathematica Working-age people with disabilities fare poorly in the workplace compared with workers without disabilities, Stapleton said. In 2012 only about 27 percent of workers with disabilities were employed, compared with 71 percent for those without disabilities, and their poverty rate was 31 percent in 2012 versus 12 percent for their peers.1 Among those who were beneficiaries of Social Security Disability Insurance (SSDI)
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From page 29... ...
. In 1980 about 2.8 million people under age 65 were receiving Social Security disabled worker benefits; by 2010 this num ber had risen to 7.8 million.
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Stapleton briefly described three proposals he suggested could lead to large-scale change: 1. One would require that employers provide a mandatory 2-year private disability insurance program for their employees.
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Under this proposal every state would have its own disability policy board, with consumers represented through an independent consumer review board. State and local chapters of the review board would monitor changes, and a federal appeals process could be in place for individuals who think they are being harmed by the waivers being granted.
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From page 32... ...
Responses to the waiver process and budget projections could vary. The default response would be no response and a continuation of current programs, while the preferred response would be for federal agencies, states, localities, and private entities to propose waivers designed to improve economic and other outcomes and reduce expenditures relative to budget projections.
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From page 33... ...
Institution-based LTSS account for 45 percent of Medicaid LTSS expenditures, with home- and community-based LTSS accounting for 29 percent of all Medicaid LTSS expenditures.3 While 61 percent of elderly beneficiaries rely on institution-based services, only 21 percent of nonelderly beneficiaries with disabilities access institution-based LTSS. Total Medicaid long-term care per capita expenditures are highest for nonelderly 3 The balance of Medicaid expenditures for LTSS attributable to mixed long-term care (4 percent)
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From page 34... ...
Spending for HCBS for elderly beneficiaries as a percentage of total Medicaid long-term care expenditures for the elderly varies dramatically across the states, from less than 10 percent in seven states to more than 40 percent in seven states and the District of Columbia. For nonelderly people with disabilities, Medicaid HCBS spending as a percentage of total Medicaid long-term care expenditures for nonelderly people with disabilities ranges from less than 50 percent in six states to greater than 80 percent in eight states.
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From page 35... ...
The health homes state plan option, which 25 states are implementing or have planning grants for, is a new Medicaid benefit aimed at allowing states to coordinate care for individuals with chronic conditions; states electing this option receive 90 percent enhanced federal funding for the first 2 years. The new Balancing Incentive Program provides enhanced federal matching funds for states that spent less than 50 percent of their Medicaid long-term care dollars on HCBS in 2009; the goal is to increase the proportion of long-term care spending devoted to HCBS in these states, and 15 states are currently participating in the program.
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From page 36... ...
The Rationale for Social Insurance Social insurance mimics private insurance, but it can also serve broader societal goals. According to Goldberg, social insurance is flexible in that it can change in order to address unforeseen developments, whereas private contracts tend to be overly specific and rigid.
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From page 37... ...
France has one of the highest rates of private long-term care insurance despite a strong social insurance program with an HCBS benefit and a cash benefit. Many governments rely on mandatory social insurance not just for LTSS but also for pensions, Goldberg said, whereas the United States continues to rely on means-tested programs and tax expenditures.
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From page 38... ...
Support for social insurance among policy makers could be bipartisan, he said, if the system were selffinanced, if it reduced Medicaid spending, and if it complemented private insurance. Such a program would not need to address all of the risks a person faces.
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From page 39... ...
One thing is certain, said Goldberg: With long-term care costs projected to double by 2040, keeping the current system on autopilot is not a good option.
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