The Open Bridges Campaign
Forcing seniors into nursing homes when they do not need to be there is bad public policy.
Here's how you can help.
PLEDGE Your Support to Help us change the california coordinated care initiative to allow seniors the options of receiving care in residential care facilities for the elderly.
The Supreme Court Olmstead decision mandates states allow low-income seniors the right to self-direct their care to home and community-based care settings instead of skilled nursing facilities (SNFs), whenever possible. The California Coordinated Care Initiative (CCI) denies Olmstead to seniors who would like to receive their care in community-based residential care facilities for the elderly (RCFEs).
There is no CCI category of aid (see the right column) for seniors who choose to receive their care in community-based RCFEs. Seniors who choose to reside in those settings are considered Community Well/Healthy even when they require too much care to remain at home.
CCI is flawed when a senior "severely impaired" while at home becomes "healthy" when he/she chooses to receive care in a RCFE. The Community Well/Healthy capitated payment (approximately $124/month) is not enough to pay for care in a RCFE.
HOW BIG IS THE PROBLEM?
The 2014 AARP/SCAN Long Term Support and Services (LTSS) report card estimates if California improved its performance to the level of the average of the top-five-performing states more than $573,100,000 more would go to home- and community-based services instead of nursing homes.
CCI is contrary to its policy goals: spending Medi-Cal dollars wisely and promoting community-based vs. institutional care when CCI Managed Care Organizations (MCOs) responsible for LTSS expenses are fully reimbursed for expensive SNFs ($5,300/month) but not enough to pay for more affordable RCFEs (average cost: $2,500-$3,000/month for a shared room).
Instead of promoting Olmstead, CCI creates perverse fiscal incentives that force seniors who can no longer live at home into expensive SNFs rather than allow them to self-direct their care to affordable, community-based RCFEs.
Add a new RCFE rate category to the CCI rate tables for seniors classified as "severely impaired" or in SNFs on LTSS who would like to receive their care in RCFEs and include Care Plan Options (CPOs) in the rate development template which provides incentives to promote community vs. institutional care options.
The new CCI RCFE rate (between HCBS High and Institutionalized) would pay for a RCFE's "assisted living" expenses and the senior's Supplemental Security Income contribution (approximately $1,014/month for a RCFE) would pay for "room and board" costs.
Adding a RCFE rate category to CCI is also a policy recommendation in a UC Berkeley/SCAN research report (p. 13 and 16) about barriers to SNF diversion/transition in California.
CCI Categories of Aid:
Institutionalized: Members with a Long Term Care aid category or residing in a nursing facility for 90 days or more
HCBS High: Members who receive Community-Based Adult Services (CBAS) or are clients of Multipurpose Senior Services Program (MSSP) sites or who receive In-Home Supportive Services (IHSS) and are classified as “Severely Impaired”
HCBS Low: Members who receive IHSS and are classified as “Not Severely Impaired”
Community Well/Healthy: All remaining members
Let's Pledge To:
promote olmstead reform in california.
Sign our on-line petition and join us as we work with other Olmstead advocacy groups to change CCI. Low income seniors deserve the right to receive care in the care setting of their choice.
Join our Open Bridges Campaign
Pledge your support and add your voice to our Open Bridges Campaign to change CCI and promote Olmstead reform in California. Low income seniors deserve the right to self-direct their care to the care settings of their choice.