Long-Term Care - Illinois General Assembly

Personal care was provided as an optional program under the State Medicaid program.
Medicaid directors around the country break out in a cold sweat, because that type of care can
become another uncontrollable cost center. Maine covers personal care under its Medicaid
State plan, and it's a very tightly controlled program. That type of care is available as a benefit,
but is also managed very carefully to keep the costs under control.
Changes were also made to the Nurse Delegation Act that allowed services to be provided at
home that ordinarily had to be delivered in a licensed facility.
Last, but certainly not least, was, at the state level, a very competent, very dedicated, very
committed staff, who have been with this process since the beginning. That was a real benefit,
because they brought a lot of experience.
There was not a lot of planning. In Vermont, a neighboring state in New England, they've been
planning for the last 20 years. In Maine, it wasn't so much ready, aim, fire. It was more fire, fire,
fire, and then go back and do mid-course corrections. It is more a matter of what works in your
state. In Maine the concern was, if you spend too much time planning, you can sort of talk
yourself out of doing some things and taking some risks. Maine just charged ahead.
Other things that helped us included the excellent data systems. Data has been crucial in
working with the legislature. Legislators often find themselves torn between the department as
the payer and the providers, and the legislators are sitting there saying: “Well, who do we
believe?” The data has been very helpful in providing objective information about what has
been done.
In Maine, one department manages the system: The Medicaid agency — the state agency on
aging, the licensing folks -- are all in one department. They work very closely together, and that
has certainly helped move things along. There is also no county government. .
Going to a system of acuity-based payment has also been critical. All of the programs have
been re-structured to very closely tie eligibility, scope of service, and payment. No one agency
is getting high reimbursement to care for low-acuity people. In all of the systems, those issues
are very closely tied together, and they're very similar. The higher the acuity, the higher is the
reimbursement. The lower the acuity, the lower is the reimbursement.
There is also a good partnership with the University. In many ways they serve as the honest
broker, when the legislature is looking at these issues and attempting to make a decision.
Ten years into this, Maine still faces a lot of challenges.
The labor shortage in Maine has been a problem, as in Minnesota. It's not as bad now, even
though the economy is not good, but Maine is a state that is losing young people at an alarming
rate. There is little in-migration of any kind. so the state is facing a situation, particularly in rural
areas, where the elderly population makes up 25 percent of the total population in some of
those counties. There is basically no work force out there to take care of them.
Last fall the legislature re-adopted a nursing home (Medicaid) provider tax. There was one in
the early '90s. When times were good the tax was eliminated. A year or so ago, when things
started getting bad, the legislature passed (the new) provider tax. The proceeds from that tax
have been used to help with the state budget deficit, and to pay for rate increases across the
long-term care system. Everybody shared in the proceeds from that nursing home tax — the
nursing homes, home care agencies, adult day service providers, and residential providers.
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