Not a Policy Wonk or Wannabe? Skip This Week’s Elder Law Issues

The Director of Arizona’s Medicaid program (AHCCCS – the Arizona Health Care Cost Containment System) testified last month before the United States Senate Special Committee on Aging, and his remarks caught our attention. Director Thomas Betlach was testifying about “dual eligibles” — people who are eligible for both Medicaid (AHCCCS) and Medicare. He particularly was talking about Arizona’s unusual approach, which utilizes managed care programs as the centerpiece for Medicaid recipients.

Mr. Betlach’s testimony is interesting, at least to people with a strong policy bent. You can read his remarks online and decide if that includes you. But we were not as focused on dual eligibles and managed care as we were on his description about the Arizona program as it actually operates.

For instance, Mr. Betlach reported that 72% of Arizona’s elderly and physically disabled (his term) Medicaid recipients are now receiving their care at home or in a community-based care setting — as distinguished from institutionalization in a nursing home or similar facility. For Medicaid recipients with a developmental disability, that figure increases to 98% — in other words, only two percent of Arizona’s Medicaid-subsidized patients with developmental disabilities are in long-term care institutional settings.

Whatever you may think about Arizona’s history of care for vulnerable patients (and we are not always big fans), that is pretty remarkable. Of course a significant percentage are receiving their care in assisted living facilities or adult care homes — not nursing homes, but not exactly home, either. Mr. Betlach’s testimony did not segregate out the numbers or percentages for those populations, but we are still impressed with the high percentage being cared for in settings other than nursing homes.

Another interesting element of Mr. Betlach’s testimony: the managed-care emphasis in Arizona’s AHCCCS program has helped increase the percentage of managed-care patients in Medicare, and has held down the costs of (among other things) prescription drugs and the long-term care costs themselves. And the savings at least arguably demonstrate better care: Arizona’s Medicare/Medicaid patients  have a one-third lower hospitalization rate and a 21% lower readmission rate after release from hospitalization.

Want to know more about AHCCCS, the Arizona Long Term Care System (ALTCS) and Home and Community Based Services (HCBS)? You might want to look at the AHCCCS reports page. From there you can link to reports prepared for the federal government, for the state legislature and other reports. One we found particularly interesting: a report to the federal government on HCBS care (the latest year available is calendar year 2010).

Haven’t yet satisfied your inner wonk? Try the population statistics maintained by AHCCCS on its members and trends. Our favorite: we did not realize that the number of AHCCCS/ALTCS patients with developmental disabilities (24,654) was so close to the number of members listed as “elderly” or “physically disabled” (27,941). The former category seems to be growing ever-so-slightly faster than the latter, and that surprised us as well.

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2 Responses

  1. Thank you for this article. After being embarrassed so often by the bad behavior and social services statistics of Arizona, this is a pleasant surprise. I think people need to remember that the recent AHCCCS cuts were done by politicians, not the management of AHCCCS.

  2. Perhaps I am speaking too much from a glass half full perspective, but I have been truly impressed with ALTCS’ decision making and creativity in dealing with the budget cuts. Speaking only from what I have seen in the long term care system, ALTCS has found ways to cut their budget without harming the ability to care for those that are in need. They have cut out office supplies and have made strong strides to becoming a paperless office. They have eliminated office space so that many eligibility workers work from home, thereby eliminating rent and utility bills. They have decided to cut their staff and in some offices, are functioning at 40% staff. ALTCS has been administratively strained in an effort to maintain their ability to care for all those who apply. We have yet to see an application freeze at the ALTCS office, and it is rare to hear complaints about receiving ALTCS benefits. The complaints we hear are about the complexities of getting on the system!

    It is interesting the high percentage of recipients that are not in skilled nursing facilities, however, we have seen that trend evolve in the last ten years, regardless of ALTCS eligibility. If I had to guess, I would say that between 85% and 90% of our clients do not reside in a skilled nursing facility for more than a short period of time (i.e. for rehab) and in fact, receive their long term care from adult care homes or in home care. I like the fact that ALTCS has been clever enough to contract with the providers for these alternative arrangements. Most of the time, clients prefer these settings over a skilled nursing facility, so in the end, everyone is happy. The costs for ALTCS are lower and the client gets the care in the preferred setting.

    Nothing is perfect, especially in government, but before I remove these rosy glasses, I feel it’s important to recognize and be happy that at least the Arizona Medicaid system has appeared to made some good choices for those in need.

    Victoria Blair
    Fleming & Curti, PLC
    Tucson, Arizona

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