state of alabama

638 Pages·2012·15.7 MB·English

OFFICE OF THE GOVERNOR STATE CAPITOL
MONTGOMERY, ALABAMA 36130
[phone]
ROBERT BENTLEY
FAX: [phone]
GOVERNOR
STATE OF ALABAMA
October 9, 2012
The Honorable Tom Harkin
Chairman, Committee on Health, Education,
Labor and Pensions
United States Senate
Washington, DC 20510-6300
Dear Senator Harkin:
This report is offered in response to your letter dated June 22, 2012, regarding the State of
Alabama's current or proposed use of Medicaid and other federal programs to implement the
Americans with Disabilities Act (ADA). Alabama has, and will utilize numerous such means, in
addition to its own state funding and programs, to expand community integration.
A summary of our activities to expand community living was prepared at the beginning of this
calendar year, coordinated by our lead state agency for long term care rebalancing, our Alabama
Medicaid Agency. That plan, contains highlights from each of our human service agencies that
are charged with providing services and supports to various groups of individuals in community
based settings. A copy of it is attached for your review. (Attachment 1) I believe it offers insight
into the breadth of the many initiatives Alabama has begun since the United States Supreme
Court issued its decision in the Olmstead case; many of which have happened during the time
period that you have selected for this inquiry and data, between 2008 and 2012.
Since the time of the release of our "Gateway to Community Living, State of Alabama Long
Term Care Rebalancing Initiatives, January 2012", which is our Olmstead Plan, Alabama has
continued to expand community integration for people with disabilities. As the Olmstead Plan
was being finalized, for example, the Partlow Developmental Center, the last state run
intermediate care facility for people with intellectual disability, was closed and its 156 residents
(prior to its announced closure) were transitioned to community living. Further, we announced
the closure of more psychiatric hospitals and, after years of downsizing those hospitals, having
already closed t\:vo, plus three state operated psychiatric nursing homes, just last week, we closed
another psychiatric hospital. We are currently in the process of closing still another psychiatric
hospital and anticipate its closure within the next two months. Though the earliest oppo11unity
was passed upon several years ago to apply for the "Money Follows the Person" funding, we
have recently applied for that resource and expect it, upon award, to significantly assist us in
moving Alabama forward beyond our existing resources under our current Medicaid State Plan
and waiver services. It will include resources for transitioning more individuals to, and keeping
them in community settings for people in or threatened for psychiatric hospitalization, nursing
home care and other long term institutionalization. This will also help those individuals secure
housing in conjunction with resources from other federal, state and local housing agencies.
The State of Alabama already operates seven home and community based services waivers in its
Medicaid program. (See Attachment 2.) To summarize our most recent initiatives, Alabama was
the first state to win approval for a 1915U) state plan amendment to facilitate self-direction by
Senator Harkin
October 9, 2012
Page Two
people with disabilities and the elderly population. We began work initiatives that will hopefully
lead to Alabama becoming an "Employment First" state for its people with developmental
disabilities by shifting from focus on funding day programs and sheltered work to moving
individuals into pre-vocational services as a prelude to attaining competitive employment. We are
developing a 191 S(i) state plan amendment to provide more home and community based services
to people with serious and persistent mental illness and envision it becoming operational in the
coming year. Resources from the "Money Follows the Person" award will assist us in
development of a second, "ACT II" waiver that will target a nursing home-eligible population to
receive home and community based services for people with developmental disabilities that are
not currently served by Alabama's existing array of waiver programs.
Therefore, despite the challenges of the recession that has plagued the United States and Alabama
since 2008, numerous changes have been, and are being implemented to serve and transition
individuals who in years past would have been destined for institutional settings only.
The remainder of this report will attempt to address the questions posed and data sought by this
important Senate Committee, keeping in mind that in some cases, this state may not track data in
the exact format in which the questions were raised. However, we have attempted to gather as
many answers as we could to the Committee's questions.
Thank you for continuing to provide the States with tools to better serve the elderly and people
with disabilities.
Sincerely,
-tO
C)~ -t~Q/) ~
11
~~~~~c~Nl X(lc,)
Governor
cc: Senator Richard Shelby
Senator Jeff Sessions
Stephanie Azar, J.D., Acting Commissioner, Alabama Medicaid Agency
Cary Boswell, Commissioner, Alabama Department of Rehabilitation Services
Nancy Buckner, Commissioner, Alabama Department of Human Resources
Neal Morrison, Commissioner, Alabama Department of Senior Services
Jim Reddoch, J.D., Commissioner, Alabama Department of Mental Health
Don Williamson, M.D., State Health Officer, Alabama Department of Public Health
ANSWERS TO INFORMATION REQUESTS
(I) For each yern· from FY 2008 to the presclll: The number of people who 111ovccl from nursing
lic1111esi inlcrmcdlnte c111·c focilillcs ror individuals with intellect1111I or developme11tal clisnbililies,
long term care units of psychiatric hospitals) and board and core homes (ollen called adult CiH'c
homes 01· residential hc1i!th c111·e fooillt'lcs), to living in their own home, includillg thrnugh fl
supportive housing progrnrn,
·'fyp~ ofS~tfing··~hdfo( Servi lie· ·. ...·· .. •2008 .. ·2009· .. 2010. 2011 .. ..· .. 2()12 .
Nursing Homes*
Intermediate Care Facilities- ID 2 3 3 1 to own ICFMR
home/156 closed
to ID
community
group
homes
Long Tenn Care Units - Psychiatric 20 18 25 5 1
Hospitals
Board and Care Homes* NA NA NA NA NA
Into Psychiatric Foster Care 38 56 41 20 13
Psychiatric Group Homes to Independent 439 435 430 403 343
Living (Home/A pts./Supportive Housing)
* Data not collected. The Board and Care Homes are not funded by the state.
As for nursing homes, while that data is not currently collected, when the "Money Follows the
Person" award is received, it will allow that data collection to begin.
(2) The mnoltnt of stntc clollnrs that will be spent in this fiscnl )'CCII' serving individunls wlth
disf!bililies in cnch of these settings: nursing homes, [11lcrmcdiatc erirc facilities fb1· individuals
with intcllcctunl or clcvclop111c11tnl clisnbilitics, board nnd cnrc homes, psychintrle hospitals,
group homes) nnd !heir own homes, incl11cli11g through n supportive housing progrnm.
Intermediate Care Facilities/ID 4.1
Boarding Homes* 0
L TC Psychiatric Hospitals 107
ID Group Homes 67
MI Group Homes 23
MI Faster Homes 1. 8
MI Local Crisis/ Acute Care 16
ID Living at Home Waiver 1.9
ID HCBS Waiver besides Group Homes+ Case Mgt 29.7
ID Community Supp01is** 1.8
MI Supportive Housing 2.5
3
I MI Semi-Independent Intensive apartments I 1.7
** Unmatched state dollars spent in the community
##############################################################################
Other waiver and nursing home information indicating people served and dollars spent.***:
2008 2009 2010 2011
Recipients 65 120 129 142
HIV Expenditures $247,533 $545,935 $762,643 $904,601
Recipients 5,157 5,160 5,101 5,116
ID Waiver Expenditures $239,097,927 $268,275,927 $270,457,495 $279,003,301
Recipients 8,859 8,889 8,774 8,377
EDW Expenditures $84,689,595 $91,155,467 $90,177,052 $92,493,151
Recipients 605 578 539 516
SAIL Expenditures $6,720,128 $6,544,784 $6,131,203 $5,530,308
Recipients 447 448 527 540
LAH Expenditures $4,080,115 $4,250,847 $5,281,447 $6,150,103
Recipients 5 10
TA Waiver Expenditures $614,552 $701,123
FY08 Actual FY09 Actual FYlO Actual FYll YTD
Nursing Facility
25,747 25,787 25,464 24,606
Recipients
$832,982,860 $875,098,124 $875,903,315 $900,408,352
Expenditures
***All expenditures here are total dollars not state only dollars. FMAP is currently
approximately 68% for Alabama.
(3) For each ycm from FY 2008 to the present, the extent to which your stfllc has expanded Jts
capacity to scl'vc individuals with disabilities in their own homes, i11cludl11g through a supportive
housing prngrnm "" lnclucllng tile n1110u11t of s(fllc dollars spent on the expansion (which may
include rcalloca(ed money previously spent on segregated settings) and the specific natmc of the
capncity added,
From FY08-FY12, the Alabama Department of Mental Health (ADMH) provided an array of
community supports for individuals served by the department. In 2008, the following services
were expanded using state dollars as indicated below.
4
FY2008
Community Based Housing Service Expansion FY08
General/ Outpatient 2,956,847
Peer Specialist/Peer Bridger 1,000,000
Other Services 857,329
Mobile Teams 1,410,686
Crisis Stabilization 1,529,079
Crisis Evaluation & Support 2,850,050
Residential Group Care Home-Specialized 109,655
Residential Group Specialized Medical Home 692,360
Residential Group Specialized Behavioral Home 1,088,225
Residential Group Care Home 475,800
Foster Care Facility 1,477
MOMS 1,092,305
Supported Housing
• EBP 2,012,640
• Assisted Living 623,614
Child Residential 206,744
In FY09-FY10, because of the extreme economic downturn, the Alabama Department of Mental
Health was unable to expand services, but was at least able to maintain the majority of service
expansions developed in FY08. In FYl 1 and FY12, ADMH continued with the community
support expansion plan established in previous years. The following chart depicts the additional
expansion services for FYl 1 and FY12. The following services were expanded using state
dollars as indicated below. The expansion in FYl 1 and FY12 was created by transferring state
facility budget dollars to the community services budget. ADMH did not receive any additional
funds, but utilized reallocation of resources to increase community services and supports.
FY2011
Community Based Housing Service Expansion FY11
Peer Specialist/Peer Bridger 700,000
Other Services 2,268,084
Mobile Teams 34,370
Indigent Drug Program 3,002,454
Residential Group Care Home 1,340,000
3 Bed Group Homes 1,690,000
MOMS 2,436,000
Supported Housing (Housing Supports) 720,000
FY2012
Community .Based Housing Service. Expansion FY12
General Outpatient 187,125
Other Services 772,452
Mobile Teams 147,000
Specialized Behavioral Group Home for Deaf & 760,865
Hard of Hearing
5
(4) The contents of your state's Olmstead Plan for increasing community integration, a
description of the strategic planning process used to create it as well as any revisions that have
been made since its creation, the extent to which it incorporates any of the new tools created by
the federal government to support home and community-based services, and the extent to which
you have been successful in meeting any quantifiable goals identified within it.
(See Attachments 1 and 2.)
(5) Any policy recommendations you have for measures that would make it easier for your state
to effectively implement Olmstead's integration mandate and take advantage of new federally
available assistance.
While shovel ready projects' f-unding is understandably important, it rewards entities that have
the capacity to quickly get projects underway, rather than those populations or states that have
the most need. For example, the recently awarded HUD 811 program (which was revamped to
be a more helpful subsidy program than was the previous 811 property development program) to
help with housing for integration, rewards systems that have robust staffing and partners that
already have resources. Pro rata formula funding for such housing subsidy would aid states with
fewer resources that don't have as much infrastructure to compete with more resourced applicant
groups.
(6) Any successful strategies that your state has employed to effectively implement Olmstead,
particularly strategies that could be replicated by another state or on a national scale.
Approximately ten years ago, the Alabama Depaiiment of Mental Health partnered with the
Alabama Housing Finance Authority to utilize HUD HOME funds and Low Income Housing
Tax Credits to fund set asides of up to 15% of units of housing built for housing people with
mental disabilities to assist with the closure of multiple institutions. It was great success for just
a two-year allocation period, in providing affordable housing, even without vouchers, for
hundreds of individuals to live independently.
This initiative appems to be similar in several ways to the design of the Melville Supp01iive
Housing Investment Act of 2010, but may allow for some opp01iunities short of use of that Act's
resources.
6
ALABAMA HOME AND COMMUNITY·BASED WAIVER SERVICES
Medicaid Is a health care program for low Income Alabamians. Home and Community-Based Waiver seivices provide addiUonal Medicaid benefits to specific populations who meet special eligibility
criteria. This chart summarizes those benefits, criteria, and informs you on how to apply for a HCBS waiver.
Applicants must meet financial, medical, and program criteria lo access waiver services. The applicant must also be al risk of nursing lnslilulionalizatlon (nursing facility, hospital, ICFIMR). A client
who receives seivlces lllrough a waiver program also Is eligible for all basic Medicaid covered services. Each waiver program has an enrollment limit. Thero may be a wailing period for any
particular waiver. Applicants may apply for more than one waiver, but may only receive smvlGlls U1rough one waiver al a time. Anyone who Is denied Medicaid eligibility for any reason has a right to
appeal. Additional information can be found on Iha Alabama Medicaid Agency's website'. www.medlcaid.afabama.gov
Elderly & Disabled Waiver Intellectual Disabilities Waiver Living at Home Waiver Stale of Alabama Independent Living
(Since 1982) (Since 1981) (Since 2002) Waiver
(Since 1992)
What is To provide services that To provide service to Individuals To provide services lo Individuals who To provide services lo disabled adulls
tho purpose? allow elderly and/or lhal would otherwise require the would otherwise require the level of care with specific medical diagnoses .. who
disabled Individuals to live in level of care available in an available in an ICF/MR meet the nursing facility level of care
the community who would Intermediate care facility for the criteria
otheiwise require nursing mentally retarded
facility level of care
What Is lhe Individuals mealing the Individuals wllh a diagnosis of Individuals with a diagnosis of Mental Individuals with a specific medical
target population? Nursing Facility Level of Care Mental Retardation (MR); Individuals Retardation (MR): Individuals meeting the diagnoses
meeting an Intermediate Care Intermediate Care Facility for U1e Mentally
Facility for the Mentally Retarded Retarded (ICF/MR) Level of Care: Persons not
{ICFIMR) residing In a group home setting or
environment: Persons currently on the waiting
list for MR services
What are Ille • Case Management • Residential Habllitation • Residential Habililation • Case Management"
seivlces provided? • Homemaker Services • Residential Habilitation -other In-Home • Personal Care
• Personal Care Living Arrangement • Day Habititallon-Level t-4 • Personal Assistance Service
• Adult Day Health • Day Habilitation-Level 1-4 • Day-Habililatlon with Transportation-Level • Environmental Aa::essibUity Adaptarons -
• Day Habilitation with 1-4
• Respite Care (Skilled and • Personal Emergency Response
Transportation -Level 1-4 • Prevocational Seivices
Unskilled) System (Initial Setup)
• Prevocational Seivices • Supported Employment
• Adult Companion Services • Supported Employment • Individual Job Coach • Personal Emergency Response
•Home Delivered Meals • Individual Job Coach • Individual Job Developer System {Monthly Fee)
• Individual Job Developer • Occupational Therapy Services • Medical Supplies
• Occupational Therapy • Speech and Language Therapy • Minor Asslstive Technology
• Speech and Language Therapy • PhysicafTherapy • Assislive Technology"
• Physical Therapy • Behavior Therapy-Leval 1-3 • Evaluation for Assislive Technology
• Behavior Therapy-Level 1-3 • In-Home Respite • Assistlve Technology Repairs
• In-Home Respite Care • Out-of-Home Respite
• Out-or-Home Resplle Care • Personal Care
• Institutional Respite Care • Personal Care on Worksite
• Personal Care • Personal Care Transportation
• Personal Care on Workslte • Environmental Accessibility Adaptations **Includes Tr ansltional Services
• Personal Care Transportation • Specialized Medical Equipment
• Environmental Accessibility • Medical Supplies
Adaptations • Skilled Nursing
• Specialized Medical Equipment • Community Specialist
• Medical Supplies • Crisis lnleivanfion
• Skilled Nursing
• Adult Companion Seivices
• Crisis Intervention
• Community Specialist
Waiver criteria : Nursing facility level of care JCF/MR level of care !CF/MR level of care Nursing facility level of care
wnat groups • Individuals receiving SSI • individuals receiving SSI • SSI recipients • Individuals receiving SS!
I can • Individuals receiving Stale • SSI related protected groups • Federal or Stale Adoption Subsidy Individuals • Individuals receiving Stale
I for Supplementation deemed lo be eligible for • SSI related protected groups deemed to be Supplementation
• SS! related protected groups SSI I Medicaid eligible for SSI I Medicaid • SSI related protected groups deemed lo
deemed to be eligible for SSI I • Special HCBS waiver disabled • Low Income Families with Children be eligible for SS! I Medicaid
Medicaid individuals whose income is not • Special HCBS waiver disabled individuals
• Special HCBS waiver disabled greater lllan 300% of the SSI whose Income Is not greater than 300%
individuals whose Income is Federal Benefit Rate of the SSI Federal Benefl!Rate
not greater than 300% or Ille • Low Income Families with
SSI Federal Benefit Rate Children
• Federal or State Adoption • Federal or State Adoption Subsidy
Subsidy Individuals Individuals
Enrollment Limit 9,205 .\,260 569 660
Is there an age No age requirement 3 years and older 3 years and older 18 years and older
requirement?
Who provides Casa Dept of Senior Seivices Dept or Mental Heallll Dept of Mental Health Dept or Rehabilitation Services
Management?
'l'l!lare 1090 to
Dept of Senior Seivices Depl of Mental Heallll Dept of Mental Health Dept or Rehabilltalion Seivlces
oo how to apply? www.adss.alabama.gov www .mh.alabama.llilY www.mh.alabama.gov www.rehab.alabama.gov
'hho aie lhe Jean Stone DMH /ID Call Center DMH I ID Call Center Karen Coffey
ron!act parsons? 1-800-243-5463 1-000-361-4491 1-800·361-4491 1-800-441-7607
Willodean Ash Willodean Ash
r334\ 242-3701 13341242-3701
\'\Iha\ are Iha Code of Federal Regulations: 42 Code of Fedaral Regulations: 42 CFR Code of Federal Regulations: 42 CFR 440.180 and Code of Federal Regulalions: 42 CFR 440.180
refmence sources? CFR 440.100 and 441.300 440.180 and 441.300 441.300 and441.300
Polley provision far providers: Policy provision for providers: Mod!cald Policy p1ovisioo for pro'<iders: Medicaid Admln Code Policy provislon for provldorn: Medicaid Adrn!n
Medicaid Admin CC<fo Ch. 36 Admin Code Ch. 35 Ch.52 Code Ch. 57
''S11ec1fic mcd1cn.I dmgno5cs mdutlc:, hul 1uc uot lnnilcil to: Qt1ntln11lcgrn, Tnuumitlc Bniln Injury, Amyotm11hic Lntcr1tl Sdcro.s1s1M ui11plc Sclemsis, SJmHtl l\huculltr Atm11hy, Mu11cular Uysh1•1•hy, SC\'Crc
Ccrehrnl Pnl:iy, Slrnkc, nml olhcr li1thst11.nih1t ncun1logicffl h111111h'TI1e11ts1 SC\'C~ly dd1ilitating dhmasl!f, nr rare genetic dlsc11ses (such us Lc.'lcti-Nyh;m disease),
ALABAMA HOME AND COMMUNITY-BASED WAIVER SERVICES
Technology Assisted Waiver for Adults HIV/AIDS Waiver Alabama Community Transition (ACT) Waiver
(Since 2003) A.K.A. 530 Waiver (Since 2011)
(Since 2003)
What is To provide services to adults with complex To provide services to Individuals with a diagnosis of To provide services to individuals with disabilities or long
the purpose? skilled medical conditions who would HIV, AIDS, and related illness who would meet the term illnesses, who live in a nursing facility and who
otherwise require nursing facility level of care nursing facility level of care criteria desire to transition lo the home or community setting
What is the Individuals with complex skilled medical Individuals with a diagnosis of HIV or AIDS and related Individuals with disabilities or long term illnesses
target population? conditions who are ventilator dependent or illnesses. currenlty residing in a nursing facility.
who has a tracheostomy.
What are the • Private Duty Nursing • Case Management* • Case Management
services provided? • Personal Care/Attendant Services • Homemaker Services • Transitional Assistance
• Medical Supplies • Personal Care • Personal Care
• Assistive Technology • Respite Care • Homemaker Services
• Skilled Nursing • Adult Day Health
• Companion Services • Home Delivered Meals
• Respite Care (Skilled and Unskilled)
• Skilled Nursing
• Adult Companion Services
• Home Modifications
• Assistive Technology
• Personal Emergency Response Systems (PERS)
Installation/Monthly Fee
• Medical Equipment Supplies and Appliances
"*Targeted Case Management which
includes transitional services. (A covered
service under Medicaid's Slate Plan)
*Includes Transitional Services
Waiver criteria: Nursing facility level of care Nursing facility level of care Nursing facility level of care
What groups • Individuals receiving SSI • Individuals receiving SSI • Special HCBS waiver disabled individuals whose
can be eligible • SSI related protected groups deemed to be • Disabled individuals with income up to 300% of the income is not greater than 300% of the SSI Federal
for this waiver? eligible for SSI SSI income level Benefit Rate
• Special HCBS waiver disabled individuals • Individuals receiving SSI
whose income is not greater than 300% of • Individuals determined to be eligible for transition into
the SSI Federal Benefit Rate the community based upon an assessment
• Individual that have been in the nursing facility for 90
days or more
• Individuals that are expected to move into the
community within 180 days
Enrollment Limit: 40 150 200
Is there an age requirement? 21 years and older 21 years and above No age requirement
Who provides Case Department of Rehabilitation Services Department of Senior Services Department of Rehabilitation Services
Manaeement?
Where to go to Alabama Medicaid Agency Department of Senior Services Dept of Rehabilitation Services
receive information www.medicC1id.a!abama.gov www.adss.alabama.gov www.rehab.alabama.gov
on how to apply?
'Mio are the Karen Coffey Jean Slone Karen Coffey
contact persons? 1-800-441-7607 1-800-243-5463 1-800-441-7607
'Mlal are the reference Code of Federal Regulations: 42 CFR Code of Federal Regulations: 42 CFR 440.180 and Code of Federal Regulations: 42 CFR 440.180 and
sources? 440.1 BO and 441.300 441.300 441.300
Policy provision for providers: Medicaid Policy provision for providers: Medicaid Admin Code Policy provision for providers: Medicaid Admin Code Ch.
Admin Code Ch. 54 Ch. 58 44
2
THE STATE Department of
Health and Social Services
0
~LASKA
OFFICE OF THE COMMISSIONER
Anchorage
GOVERNOR SEAN PARNELL
3601 C Street. Suite 902
Anchorage. Alaska 99503-5924
Main: 907.269.7800
Fox: 907.269.0060
August 30, 2012
The Honorable Tom Hark.in, Chairman
Unites States Senate Committee on Health,
Education, Labor, and Pensions
Washington, DC20510-6300
Dear Senator Harkin:
Thank you for your letter of June 22, 2012 to Governor Parnell regarding Alaska's services to
individuals with disabilities. The Governor has requested that I respond to you on his behalf.
Alaska has been a forerunner in the promotion of community integration for individuals with
disabilities. In 1997 the state's only Intermediate Care Facility for Intellectually and
Developmentally Disabled individuals was closed. Shortly thereafter the private agency, Hope
Cottages, also closed their small facilities thereby making Alaska the first state in the country
with no public or private institutions for individuals with intellectual and developmental
disabilities.
In 1999 the Substance Abuse and Mental Health Services Administration (SAMHSA) awarded
funding for the Department of Health and Social Services (DHSS) Community Mental
Health/A laska Psychiatric Institute Replacement project to develop an integrated system of care
for individuals with mental health and substance induced crises. As a result of this project, the
state's only public inpatient psychiatric hospital, originally equipped to house 242 patients,
downsized to a bed capacity of 80.
Additionally, Alaskans are currently able to access fewer than 700 nursing home beds. As a
result of these few in-state institutional resources for individuals with these very high needs, our
home and community based care delivery system has become very robust and innovative in
providing necessary care in the least restrictive setting possible.
Your letter references several opportunities Congress has made available to promote community
based services. While these opportunities may be beneficial for some states which do not have
the same high ratio of individuals with high needs being served in the community, they actually
have created additional challenges for Alaska
The Community First Choice option held promise initially for Alaska, as a way to redefine our
personal care attendant (PCA) program and increase the quality of our existing program utilizing
the federal Medicaid match enhancement afforded by that program. Unfortunately, the final rules
Senator Tom Harkin
August 30, 2012
Page2
imposed a restriction that all participants meet an institutional level of care to qualify. If Alaska
chose to redefine our existing state plan PCA services program using the Conununity First
Choice option, approximately 50% of those individuals currently enrolled in the PCA would lose
that service and their conditions would almost surely worsen. In order to cover the entire
population receiving these services Alaska would be forced to administer two separate programs,
each serving approximately 2,500 individuals. This is an unfortunate result of the final rule
implemented by CMS.
Another tool you reference in your letter is the Balancing Incentives Payment Program that
provides enhanced federal Medicaid match for expanding home and community-based services.
The eligibility for funding for this program was based upon FFY 2009 long tenn support services
(LT SS) Medicaid experience. Alaska's LTSS spending demonstrated that 62. 7% of the LT SS
funds were expended for home and community based settings (ranked 6th in the nation). Because
of that benchmark perfonnance we were not able to participate in this enhanced funding
opportunity.
In your June 22, 2012 correspondence you ask for responses in some very specific areas. In the
six enumerated areas below we provide you with the information that is currently available. In
some cases, the specific data requested is not available.
1. For each year from FY 2008 to present: The number of people who moved from nursing
homes, intermediate care facilities for individuals with intellectual or developmental
disabilities, long term care units of psychiatric hospitals, and board and care homes (often
called adult care homes or residential health care facilities), to living in their own home,
including through a supportive housing program.
Skilled Nursing Facility residents who returned to home:
SFY2008: 79
SFY2009: 101
SFY2010: 104
SFY2011: 92
Intermediate Care Facility for Individuals with Intellectual or Developmental Disabilities (out
of-state) :
SFY2008: 1
SFY2009: 2
SFY2010: 1
SFY2011: 1
SFY2012: 1
Inpatient psychiatric stay greater than 60 days who returned to community living:
CY2008: no data
CY2009: 21
CY2010: 32
CY2011: 36