Medicare- Administered by the Federal Government
Overview of Long-Term Care Services in Minnesota
Long-Term Care refers to the services needed to assist the aging population in Minnesota.There are a number of settings where care for the aging population is provided. These settings include:
- Nursing Facilities
- Home and Community-Based Services, including
- the Client’s Home,
- Registered Housing with Services(HWS) including Assisted Living
- Adult Foster Care
In addition to private resources, commercial and long-term care insurance, social security benefits, and other pensions, the Medicare and Medicaid programs also pay for long-term care services.
What is the difference between Medicare and Medicaid?
Medicare provides health insurance for primary and acute care services, including a skilled nursing facility benefit after a three day hospital stay, and prescription drug benefits for anyone age 65 and older, and people under 65 who are disabled. Medicareis administered and paid by the federal government.
- Medicare Part A covers hospital stays and some skilled nursing stays; home health care such as physical, occupational, and speech therapy that is provided on a part-time basis and deemed medically necessary.
- Medicare Part B covers most outpatient medical services.
- Medicare Part D provides a prescription drug benefit.
Medicaid provides daily assistance and care beyond Medicare’s episodic coverage for those aging individuals with limited financial resources.Medicaidor Medical Assistance (MA) is means-tested health and medical services program for certain individuals and families with low incomes and few resources that the State of Minnesota operates under the oversightof the federal government.
- The State of Minnesotaestablishes its own eligibility standards,determines the type, amount, duration, and scope of services, and sets the rate of payment for service.
- For the 2012-2013 biennium, every dollar spent by the State of Minnesota on Medicaid programs is matched by the Federal Government.
How does Minnesota pay for Medicaid clients that receive services in a nursing facility?
The state of Minnesota establishes Medicaid rates for Minnesota’s 381 nursing facilities. The rates were not increased in 2009 and 2010. In 2008, there were nearly 11 million paid nursing facility days in Minnesota: 58% were Medicaid, 26% were private pay, 9% were Medicare, and about 7% were paid by commercial and long-term care insurance.
Nursing homes in Minnesota chargeprivate-paying residents basically the same rates thatMedicaid pays for similar services - a policy known as rate equalization.Minnesota Statute 256B.48, Subd. 1 prohibits nursing homes from charging private paying residents any more than the Medicaid rate. Currently, Medicaid pays $20.31per patient per day on average below allowable costs for Nursing Home care statewide.
How does Minnesota pay for Medicaid clients that receive services in their Home, Adult Foster Care or Housing with Services including Assisted Living
At nearly $60,000 per year, nursing facilities are very expensive. During the 1990s, the State of Minnesota followed private paying individualsinto the assisted livingmarket by establishing waiver programs. By definition, the waiver programs are less expensive and non-institutional.
These waiver programs include:
- Elderly Waiver (EW). EWfunds home and community-based services for people age 65 and older who are eligible for Medical Assistance (MA) and require the level of medical care provided in a nursing home, but choose to reside in the community. Covered services include visits by a skilled nurse, home health aide, homemaker, companion, personal care assistant, as well as home-delivered meals, adult day care, supplies and equipment, home modifications, and certified community residential services (assisted living, foster care, residential care). Legislative cuts in 2009 and 2010 and other administrative actions have cut the Elderly Waiver program by more than 10 percent.
- Community Alternatives for Disabled Individuals (CADI)Waiver. CADI provides funding for home and community-based services for children and adults, who would otherwise require the level of care provided in a nursing facility. CADI Waiver services may be provided in a person’s own home, in his/her biological or adoptive family’s home, in a relative’s home (e.g. sibling, aunt, grandparent etc.), a family or corporate foster care home, and Housing with Services including Assisted Living.
- The Traumatic Brain Injury (TBI) Waiver. TBI provides funding for home and community-based services (HCBS) for children and adults who have an acquired or traumatic brain injury. TBI Waiver services may be provided in a person’s own home, in his/her biological or adoptive family’s home, in a relative’s home (e.g. sibling, aunt, grandparent etc.), in a family or corporate foster care home, and Housing with Services including Assisted Living.
Oversight
Nursing Home Regulatory Environment
Most Minnesota nursing homes are certified to participate in the Medicare program. Certified facilities must comply with over 200 Federal Nursing Home regulations, and are surveyed, on average, every 12 months. All nursing facilities must also be surveyed every 24 months for compliance with duplicative Minnesota Nursing Home regulations.
Housing and Residential Settings including Assisted Living
Housing with Services (HWS) establishments (mostly Assisted Living) must register with the State Health Department. Currently, 1,125 of the 1,700 Housing with Services establishments have the Assisted Living Designation. Home Care Agencies must comply with Minnesota Home Care Rules (including Class F agencies that provide services within HWS establishments). Some Home Care Agencies (Class A) are also Medicare Certified, requiring compliance with Federal Home Care regulations.
Care Providers of Minnesota, 12/2010