Long-Term Care - Illinois General Assembly

Minnesota needed to change, in terms of mainstream services, specifically in terms of the
impact on the state budget, and particularly for long-term care. From that discussion, the
Governor became very interested in long-term care reform and established a long-term care
task force.
Those were the days that Minnesota was “tri-partisan.” The Governor was an Independent.
The Senate was under Democratic control and Republicans were in the majority in the House.
Each group had a number of people on the task force. There were also several commissioners
from the Executive branch.
The task force used a process fairly similar to the discussion about demographic shifts in our
“2030” project. It conducted hearings across the state, with task force members looking at a lot
of the data, looking at budgets, and talking about what could be done to better balance the
long-term care system, which, like many states across this country, was extremely biased
toward institutional care — just the opposite of what people are mostly looking for and what we
certainly heard from mainstream Minnesotans.
Minnesota is a strong, county-based system. Long-term care is administered through our
long-term care human service agencies at the county level.
Minnesota's process was based on a planning process and on establishing benchmarks that we
used to help us understand how well we were achieving a more balanced long-term care
system.
Minnesota spends about $1.1 billion annually for long-term care of the elderly, about 78% of our
federal and state Medicaid budget. All the state aging program dollars are included in that
amount, About $890 million is invested or spent on nursing home care, and $250 million, about
22%, is spent on home and community-based care. In 2000 and 1998, which really is the
benchmark year, the amounts are similar. The home and community-based services were about
14% and our institutional care spending was 86%.
Some changes have occurred within past 2 years. There have been some shifts, moving into
the home and community-based service side, which is what Minnesota is attempting to
accomplish.
Minnesota has an elderly (Medicaid) waiver and a state-funded-like-waiver program called the
Alternative Care Program, which serves about the same number covered by the elderly
(Medicaid) waiver program. There is also about $15 million spent through aging service grants
that are really supplemental grants to the Older Americans Act aging network system.
The task force came up with a number of recommendations. Details are available on the state’s
website — www.dhs.state.mn.us. That site includes specifics, numbers, and percentages and
also some of the planning documents.
The long-term care task force looked at what can be done to become less reliant on long-term
care institutions, and what could be done to better provide for those individuals at the lower
income and moderate income levels, in terms of more home and community-based service
options.
One of the things that became apparent in the marketplace is, if a person had lots of cash, he or
she had a lot more opportunities to look at other kinds of home and community-based service
models. A “Gaps Analysis Process” found that, If the person lived in the right area, it really
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