Wisconsin’s “Elder Boom”

Kitty Rhoades, SecretaryDepartment of Health Services

Wisconsin’s Aging Population - 2015

Wisconsin’s Aging Population - 2035

Pay Sources for Long-Term Care

• Medicaid: 42% • Medicare: 25%• Private Pay– Out of Pocket: 22%– Private Insurance/Other: 11%

SFY 2012 Medicaid Costs for Individuals Relocating from a Nursing Home to a Home- or Community-Based Setting

Ave. Institutional Costs per Day

Ave. Community Costs per Day Ave. Daily Savings Annual Savings

$143.78 $110.38 $33.40 $1,082,227

Aging Population Projections

2005 2010 2015 2020 2025 2030 2035

726,280 782,810 900,170 1,060,620 1,234,600 1,402,900 1,485,570

Wisconsin Medicaid Long-Term Care Programs

• Fee-For-Service Nursing Home– Statewide

• Legacy Waiver Home- and Community-Base Services– 15 counties

• Managed Long-Term Care Programs (e.g. Family Care): nursing home and home- and community-based services– 57 counties

• IRIS: self-directed home- and community-based services– 57 counties

Strategies to Control Costs

• Aging and Disability Resource Centers• Reduce Nursing Home Utilization• Reduce Need for Higher Cost Services– Medication Compliance– Dementia Care– Falls Prevention– Employment/Vocational Programs– Residential and Natural Supports

• Reduce Administrative Burden on MCOs• IRIS Initiatives

Controlling Future Cost Growth: Capabilities of Managed Long-Term Care

• Payment structure that drives Managed Care Organizations to continuously improve and provide the most cost-effective care.

• Equal access to long-term care services in an individual’s home, community-based settings, or nursing homes, which assures that the level of service matches a member’s needs

• Efficiencies from MCO-developed regional and comprehensive provider networks that increase the variety of services available to member at negotiated, competitive rates.

Conclusion

• Family Care, and the entitlement of support in homes and community-integrated settings, allows Wisconsin residents to receive cost-effective long-term supports.

• Managed long-term care is the most effective strategy to meet the needs of Wisconsin’s residents.

Thank You