A View from Washington

State

1

Community First Choice Option1915(k)

• Requires additional services in tandem with personal care -- training to accomplish ADL’s, backup systems; employer functions

• Includes optional services: transition costs (damage deposits, household goods) and services that substitute for human services (e. g. electronic medication reminder)

• 6% additional FMAP is attractive

• MOE on state funds for the first year is a concern that needs to be carefully evaluated in current budget climate

• Washington is looking to the possibility of moving its Medicaid Personal Care population and possibly some 1915(c) waiver clients to 1915(k)

• The current budget situation requires any move be contingent on not spending more state funds

•We are currently modeling cost projections and awaiting further federal guidance

A View from Washington

State

2

1915 (i) Option• The most attractive aspect was the ability to cap enrollment

• Allowed targeted expansion of options without creating a new entitlement

• In these financial times removal of the ability to control growth means there is little advantage

• In this budget climate that outweighs other positives: -- Ability to target specific groups -- Ability to reach people before they reach institutional levels of care • The same array of services can be offered under a 1915 (c) waiver

A View from Washington

State

3

Better Coordination Of Service to Duals

• Better coordination between the federal government and states will improve access and quality of care

• Washington’s fee-for-service long-term care system under Medicaid supports 17,000 of the most medically expensive people for the state and federal government. About two-thirds of those are duals

• In Washington State we have made extraordinary efforts to manage long-term care costs and have recently looked more closely at how our efforts affect medial costs

• We’ve proven in limited pilots that what happens in long-term care can positively affect bottom-line medical expenditures

• Bringing those efforts to scale to the benefit of all will require joint federal and state efforts to design and test new models for delivery and payment