As previously discussed, the Patient Protection and Affordable Care Act has addressed many aspects of the health care sector, including nursing homes and long-term care facilities. The Affordable Care Act, or “Obamacare” as it has been colloquially known, has in broad respects sought to increase access to healthcare for many more Americans, while trying to keep costs down. One way of keeping costs down has been the “Balancing Incentive Payments Program” (BIP Program). It has been funded to the approximate tune of $3 billion, and aims at decreasing the costliness of care for those needing nursing homes by having patients receive that care at home. This has also been called “community-based” care. At least a dozen states have participated, including Illinois.
The New Elder Care Program
The Balancing Incentive Payments Program was conceived as a remedy to the costliness of using nursing homes. Specifically, it “authorizes to States to increase access to non-institutional long-term services and supports.” It accomplishes this by beefing up the Medicaid funds sent to states, which can spend that money on “home and community care” until September 2015 so long as certain conditions of efficiency are met. Many elderly and otherwise disabled individuals prefer to receive health assistance and care in their own homes, rather than be admitted for nursing home residency. Being treated and cared for at home allows them to be in familiar and comfortable surroundings.
Medicaid funds help lower income individuals with care, as well as those with higher incomes who end up using most of their assets to pay for care and run out of money to do so. A few years ago, the U.S. Department of Health and Human Services estimated that the average cost of caring for an individual in a nursing home in 2010 was an astounding $6,235 per month. Studies have shown that Medicaid money goes much further in at-home care for individuals, who can spend that money for at-home care under a Medicaid waiver. Given this greater efficiency for less cost per person, initiatives over time have sought to increase treatment and care at Medicaid recipients’ homes, and this latest program of Obamacare takes it another step. The program pushes state agencies to encourage those looking for care to do so at home if possible, and also requires a standard criteria for eligibility to qualify (a “Single Entry Point” into the system) for Medicaid-funded at-home care as well as a case manager for each patient who is not employed by or takes direction from health providers like nursing homes.
The BIP program has stated more long-term goals as improving performance and efficiency of care for Medicaid recipients while providing more care at home. This also reduces costs where funds would not be directed nearly as much to nursing homes and long-term care facilities, which cost a pretty penny. The program also states as its goals the improvement of oversight, as well as improved assistance to patients and their families in care planning. Illinois had its application for the program approved one year ago in June 2013. Because the payments matches from the selected federal funds are indexed or tied to the percentage of a state’s long-term services and supports spending, Illinois will enjoy an increase of 2% in federal matching through BIP which it can use to divert patients from nursing homes to more efficient at-home/community-based care where appropriate. This has been estimated to be a roughly $90 million award in Medicaid funding.
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