Close Close

Life Health > Long-Term Care Planning

GAO: Medicaid Home Care Services Vary Widely

Your article was successfully shared with the contacts you provided.

NU Online News Service, Oct. 3, 6:25 p.m. – Life insurers and insurance agents now have a new source of data to back up warnings to prospects against depending on Medicaid to pay for long-term care.

A new report from the U.S. General Accounting Office shows that elderly U.S. residents who need home care and other forms of community-based care to stay out of nursing homes get far more help from Medicaid programs in some states than in others.

“These differences were due in part to the very nature of long-term care needs,” Kathryn Allen, a GAO health insurance analyst, testified at a recent hearing of the U.S. Senate Special Committee on Aging, according to a written version of her remarks.

Policymakers still disagree about the best strategies for helping elderly people with disabilities, Allen said.

But Allen said state funding and policy decisions also play a role in shaping the kind of care residents receive.

GAO researchers studied variations in Medicaid home care services by developing vignettes for two hypothetical elderly people: Abby, an 86-year-old woman with severe arthritis, and Brian, a 70-year-old man with moderate Alzheimer’s disease. The researchers then asked 16 Medicaid case managers in Kansas, Louisiana, New York and Oregon to recommend care plans for Abby and Brian.

The GAO researchers found enormous variations in the options presented.

When researchers told case managers that Abby lived alone, the amount of home care offered ranged from 12 hours per week to 49 hours per week. The stingiest case manager was one of the four in Kansas, and the most generous was one of the four case managers in New York.

When researchers told the case managers that Brian lived with his wife, who was in poor health, the amount of home care offered to Brian ranged from six hours per week to 35 hours per week. Both the stingiest and the most generous offers came from case managers in New York.

State Medicaid long-term care expenditures for 1999 averaged $2,463 per elderly resident in New York, $1,012 in Louisiana, $935 in Kansas, and only $604 in Oregon.

But Oregon could afford to spend more on home care, because it devoted a far larger proportion of its Medicaid long-term care funds to home care, day care and adult foster care and far less to nursing home care, Allen said.

Because of the differences in funding and strategy, Kansas has a waiting list of 290 people for a community-based care program that serves 6,300 people, while Louisiana has a 5,000-person waiting list for a similar program that serves only 1,500 people.

In contrast, Oregon has no waiting list for a community-based care program that serves 12,000, and New York has no waiting list for a program that has no enrollment cap at all, according to GAO figures.

Medicaid is a government insurance program for the poor. It is often described as a state-funded program, but Allen notes in her report that the states account for only 43% of Medicaid’s budget.

Links to the GAO report and other documents presented at the Senate aging committee hearing are available at