News Release

HHS Announces New Medicaid Program to Deliver Care at Home

HHS Secretary Mike Leavitt today announced a new Medicaid program that will give elderly and disabled Vermont residents more options to remain in their homes and communities and out of institutions.

"This innovative new program furthers President Bush's goal in the New Freedom Initiative which is to give people 'new freedom' to decide where and how they receive the care they need," Secretary Leavitt said. "We are working to promote innovations through Medicaid that offer more long-term care options that allow people to live more independently at home."

The Vermont Long Term Care Plan, administered under a Section 1115 waiver of current Medicaid rules, will establish a unique triage system to evaluate the appropriate type of care for enrollees who may be at risk of institutionalization.

The assessment would determine what kind of services the Medicaid program would provide. Those determined to be in the "highest tier" of need would be offered a traditional nursing facility or whatever expanded services were needed to keep them in their own homes. Those in the second tier who need fewer or less intensive services, could still receive nursing home or home-based care, but would be served in the order of greatest need. The second tier beneficiaries would continue to receive acute care and other supportive services. The program will expand community-based services to 950 older and disabled individuals who are at risk of institutionalization but would not yet qualify for services without this demonstration.

"We are using the approach that has been proven most effective in getting needed support services to more people with a disability at the lowest cost: allowing the money to follow the beneficiary�s own preferences," said Mark B. McClellan, M.D., Ph.D., administrator of the Centers for Medicare & Medicaid Services, the agency that oversees the Medicaid program. "This program will provide important evidence on how to end the institutional bias in Medicaid, to allow people with a disability to live in the community when they prefer to do so, without increasing Medicaid costs."

The demonstration will include about 4,500 Medicaid recipients who are age 65 and older and adults with physical disabilities. The state will add resources each year to the long-term care system, equivalent to a minimum of 100 additional Home and Community Based slots. To assure high quality services are being delivered to all participants in the new program, a quality assurance program and an independent advocacy system, the State and Local Long Term Care Ombudsman Program, will be available to persons in the new program.

Medicaid is a state/federal partnership program that provides health care benefits to over 53 million low-income Americans including children, the elderly and persons with disabilities. Nearly $300 billion dollars was spent on Medicaid services in 2004.