Louisiana’s elderly and developmentally disabled wait longer than people in other states to get community-based services through Medicaid, the legislative auditor reported Monday.
As of October , the auditor said 54,677 people remained on lists for the various Medicaid programs with wait times ranging from 21/2 to 10 years.
The national average for home and community-based programs serving the elderly and individuals with physical disabilities is 10 months to 13 months, the audit report said.
Meanwhile, the national average wait time for waivers serving individuals with developmental disabilities is four years.
The auditor wrote that most applicants may never receive the home and community-based services they request.
From July 1, 2011 to Oct. 1, 2014, some 74 percent of applicants “were removed from the registry for reasons other than accepting a waiver slot,” including 20 percent because they had died.
The audit report comes as the Jindal administration is moving toward privatization of the management of long-term care services in Louisiana.
The Legislative Auditor’s report is designed to provide information on the current use, cost and quality of care in Medicaid Home and Community-Based Services in order to have a baseline for evaluation after privatization.
The auditor has previously done a similar report on nursing homes — the institutional part of the state’s long-term services for the elderly. Nursing home interests are trying to exempt themselves from the Medicaid managed care privatization aimed at caring for the population in the most appropriate least costly setting.
Managed care is supposed to free up dollars so more people can be served.
Department of Health and Hospitals Secretary Kathy Kliebert said the baseline data will be “very helpful to us to have for comparisons down the road.”
While the wait times for services are high, Kliebert said it is not as bad as the audit report states. In Louisiana, people are allowed to sign up as soon as they qualify for services because of the long wait times for some programs, Kliebert said. In other states people sign up when there’s a need for services which leads to fewer people on waiting lists, she said.
Other states also can provide more people with services in communities because they don’t offer as intense and expensive programs as Louisiana, Kliebert said.
The audit report revealed that average costs for the home and community-based program were less than that for care in nursing home and intermediate care facilities for the developmentally disabled.
The average cost for home and community-based programs per person ranged from $21 to $135 a day, depending on the type of program and services delivered. In comparison, nursing home rates ranged from $139 to $187 a day and intermediate care facilities $160 a day.
About $797 million was spent in the 2014 state fiscal year on the home and community-based services — 23 percent of the Medicaid budget. About 36,800 people received services.
The auditor recommended that the state Department of Health and Hospitals add to its licensing requirements how often surveys of provider operations should be conducted.
Deficiencies have increased by 67.6 percent from 1,585 to 2,657 from fiscal year 2012 to 2014 because of “more stringent regulations and increased number of licensing visits,” the auditor said.
The auditor also suggested that DHH compile information on the quality of individual direct care providers so it is readily available to the public.