IN THE STATES: Idaho Innovates in Home and Community Based Care

Even Leslie Clement, Idaho's Medicaid Administrator, admitted that Idaho isn't usually regarded as a hotbed of social innovation, but the AARP was impressed enough with the state's achievements on keeping people out of nursing homes to make Clement one of the featured speakers at a recent luncheon and discussion on long-term care entitled "A Balancing Act: State Long-Term Care Reform." With good reason.

Most of us don't' want to end up in nursing homes. Too often, we don't have an alternative. Many states, Idaho among them, have been exploring ways to provide more home and community-based care. It's cheaper. And people prefer it.

Idaho isn't among the top five or six states in terms of how much of its Medicaid long-term care budget gets spent on home and community based care, but it's still among the better performers and it's moving fast.

Clement said one innovation is to not have a waiting list. Think about it. Nursing homes are an entitlement if you qualify under Medicaid. Home and community-based alternatives are not. If you need help (and you qualify financially for Medicaid) but you are on a waiting list for community services, you end up by default in an institutional setting. That is not successful diversion, Clement pointed out.

In 1999, Idaho had 5,014 people in nursing homes. By 2004, the number had increased by only 61, to 5,075.

In contrast, the number of people receiving home and community-based care rose from 3,196 to 10,838—an increase of 7,642. That's no small potatoes.

The AARP wasn't the only group talking about long-term care that day. Our colleague Elena Harman attended a Brookings Institution event where a large and diverse group of experts such as former House Speaker Newt Gingrich, Susan Reinhard from AARP, Buck Stimson from Genworth Financial, Senator Ron Wyden of Oregon, and Representative Jim McCrery of Louisiana addressed long-term care. As you might expect, there were many different views on how to improve quality and what to do about financing. And they reminded us that over the long-run, health reform won't be complete until we also solve the long-term care crisis. A reformed, improved, high-quality care system, with less fragmentation, more coordination, will help people stay healthy. But even in the best care system, people can't stay healthy forever. We need to find high-quality, cost-effective ways of providing long-term care in a variety of settings. And we're glad that Idaho is exploring how to get there.