New push to keep seniors in home, community-based programs

CHICAGO -- The federal government is pushing states to keep more low-income seniors out of nursing homes and enroll them in home and community-based programs instead.

The shift comes as demand for long-term care is rising. By 2050, the number of people older than 85 is expected to triple, to more than 18 million.

These seniors tend to have the highest disability rate and the greatest need for long-term care.

The tug-of-war between rising demand and controlling costs has advocates for seniors worrying about quality of care.

Medicaid is one of the largest expenses for states, and a it's a program they look to for savings when budgets are tight.

Medicaid spending on long-term care was $146 billion in fiscal year 2013, including nearly $89 billion just for seniors.

Advocates say programs for seniors often wind up on the chopping block.

For example, Illinois is considering changes to its home and community-based program that would reduce funding by about $200 million.

"I think that oftentimes people are afraid of change, regardless of what that change is," said Andrea Maresca, director of federal policy and strategy at the National Association of Medicaid Directors.

There's room to improve the programs, Maresca said, and states are trying to make sure seniors don't lose access to services.

Loren Colman of the Minnesota Department of Human Services said it took that state about 25 years to shift from institutional care to home and community-based programs.

To rein in costs, some states are changing payment systems from fee-for-service to managed care, which generally pays a per-person rate to providers who manage seniors' health and social services.