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Population-Based Health Policy: Elderly

Dr Alvandi is an enthusiastic honors health science practitioner with extensive experience in teaching and clinical roles in health care. She is a former clinical educator in cardiology, where she provided support and learning experiences to students and new staff. She played a role in educating, supporting, and guiding students from the time they arrived until evaluation and beyond in a clinical setting. She helped students to become proficient at organizing and coordinating work, prioritizing tasks, and multi-tasking. Dr Alvandi has published an article with The American Journal of Accountable Care that explores the role of electronic databases in healthcare environments.
The elderly population in the United States is growing significantly. In 2000, the population 65 years of age and older was estimated 35 million; however, this figure is expected to reach 72 million by 2030. Similarly, the number of individuals 85 years and older is predicted to be doubled from 4.2 million in 2000 to 8.7 million in 2030.
People who are 80 years and older most likely need long-term care due to severe disabilities. Long-term care includes health, social, housing, transportation, and an any other services that are required by individuals with physical, mental, or cognitive disabilities that hinder them to have independent living. The urgency for long-term care services is characterized by assessing an individual’s impairment of activities of daily living (ADLs), such as eating, dressing, bathing, toileting, and getting in and out of bed; and instrumental ADLs, such as laundry, housework, meal preparation, grocery shopping, transportation, financial management, taking medications, and communication through telephone. It is estimated that 12 million individuals in the United States need assistance with one or more ADLs or instrumental ADLs.1
Changes to Long-Term Under the Affordable Care Act
In 2010, the Affordable Care Act (ACA) provided new opportunities for elderly, caregivers, and individuals with disabilities. The law provides superior care by better coordinating medical care with easy accessible and participant-centered home and community-based services (HCBS); promotes better health through health education, assessment, disease prevention, and health promotion programs; and reduces cost through high-quality services, payment system reform, and fraud education and prevention.2
The ACA incorporated few programs and funding improvements to guarantee that people can receive long-term care services in their home or the community, which enhances existing tools and develops financial incentives for states to provide HCBS. The law enables states to target home and community-based supports to particular groups of individuals, to services that are available to more people, and to make sure the quality of the services provided. The ACA builds on successful models and provides incentives to states to extend efforts in order to offer people with disabilities more opportunities to receive long term supports and services they require in their communities with the help of programs, such as community first choice (CFC), state balancing incentive payments program, money follows the person (MFP) and demonstration grant for testing experience and functional assessment tools (TEFT).3
Community first choice
The CFC increased federal funding to states that choose to provide person-centered HCBS. The CFC helps to increase individuals’ abilities to live in the community,3 allows states to provide statewide HCBS with no enrollment caps, and assists people who would otherwise need an institutional level of care. States that decide to take this option receive a 6% increase in their medical assistance percentage for CFC services. In order to be qualified for CFC, beneficiaries must otherwise need an institutional level of care and meet the criteria for financial eligibility.
State balancing incentive payments program
As of October 1, 2011, the state balancing incentive payment program authorized grants to enhance access to non-institutional long-term services and supports (LTSS). The incentive payment program provides states that launch structural reforms to increase access to LTSS, which will ultimately increase the federal medical assistance percentage (FMAP). As a result, states that undertake less structural reforms have lower FMAP increases.3
Money follows the person
The MFP assists states to rebalance their Medicaid long-term care systems. Since December 2013, almost 40,500 individuals with chronic conditions and disabilities have been converted from institutions into the MFP program. The ACA encouraged more states to apply for the MFP program. The goals of MFP include increasing the use of HCBS and decreasing the use of institutionally-based services, eliminating barriers that prohibits the utilization of Medicaid funds in order to let people earn long-term care in the settings of their choice, reinforcing the capability of Medicaid programs to supply HCBS, and putting procedures in effect to provide quality assurance and improvement of HCBS.4 The MFP assists individuals to move out of institutions and into the HCBS. The MFP was set to expire in 2011; however, it was extended by the ACA for an additional 5 years. The MFP offers states 50% increase in federal matching for 1 year.3

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