Long-Term Care - Illinois General Assembly

eligibility determinations. Most of the case management is being done by area agencies on
aging. Over half of the people use independent providers for services. They have a strong role
for independent providers — i.e., individual providers as opposed to agency providers. Like
most states, they are struggling with limited resources. They have had to limit the number of
hours that all individuals receive services. They've now developed a system of allocating more
resources to individuals with higher levels of disability, and less to others.
Vermont has a strategic planning process. There's a website with information about that
initiative. They have done several things. They've looked ten years ahead to try to determine
disability patterns. They used a simulation-model put together by the Lewin Group. They've
done a lot of work. They set a case mix goal for of home and community-based services and
nursing home beds. They want 40 home and community-based services slots for every 60
nursing home beds. They have hard numbers on the need for services that guides planning,
and specific targets for services that they want to have in place. Looking at some of the data,
looking at where it's going to take you in the future, is a key element of what they have done.
Wisconsin is known for their current system and also their strategic planning process. They are
the state that has probably moved the farthest with what we call managed long-term care. They
have something called family care in several counties. They are providing a monthly payment
that includes funding for nursing homes, community services, and administrative costs. It's all
bundled into a single payment based on the average cost, as it is done in managed care and
acute hospital settings. This is not something that you do overnight, but they are pleased with
the results of integrating the payments, and then integrating the county resource centers, which
are single-point-of-entry for everybody, offering advice and information. Individuals that qualify
for services are overseen by county care management organizations. That system moves from
information to care management and oversight. They have a website about that reform. They
wouldn't tell you that they have this problem solved. There isn't any state that would tell you
that, but I think trying to revamp their system to deal with some of the issues that continue to
exist, including the fact that the family care system doesn't exist in every place in the state.
They want to try to see if they can come closer to making it happen, including workforce issues
and similar matters.
In Texas they passed a law that allows people who are in nursing homes who want to move into
the community to jump the waiver line. It's a special allocation of dollars in the waiver program
for people who want to leave institutions. The money essentially moves in the budgeting
system from the nursing home line to the community services line for those people that leave
the institution. It was modified somewhat this year. It's something in which Texas is very
pleased. Some states are not thrilled with that idea, because it gives preference to people who
are in institutions for services, but it is something that is getting a lot of attention.
James Varpness
Director, Aging & Adult Services Division, Minnesota Department of Human Services
(See Attachment C for power point presentation that guided this testimony)
Long-term care reform in Minnesota birthed out of the “2030” project in 1997 and 1998, in which
town hall and main-street meetings all across the state were talking about the demographic
shifts that were going to be occurring. This was called “2030,” because that was the date in
Minnesota where the 85+ population more than doubles. That got people very nervous. It got
to be very scary, specifically about state finances. The state legislature was looking at how
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