Joshua M. Wiener
Can Medicaid Long-Term Care Expenditures for the Elderly Be Reduced?, Joshua M. Wiener, The Commonwealth Fund, June 1996
In research sponsored by The Commonwealth Fund and published in The Gerontologist, vol. 36, no. 6., Joshua M. Wiener investigates whether states can substantially reduce the rate of increase in Medicaid long-term care spending for the elderly without adversely affecting beneficiaries.
Wiener, a Principal Research Associate at the Urban Institute, writes that while there are a number of proposed strategies to reduce Medicaid spending, the only way that states are likely to make an appreciable difference in expenditures is by tightening eligibility rules, reducing payments to providers, and eliminating services.
Yet eligibility standards are already strict, he points out, and reducing payment levels could lead to lower quality or access to care. If availability of services were reduced, for instance, by limiting new nursing home construction, more long-term care needs would be unmet.
Unfortunately, Wiener writes, the research literature does not offer any "silver bullets" that would allow states to obtain large savings painlessly. The hard reality, he contends, is that the current method of Medicaid long-term care financing may be the most economical. Payment rates are lower than under Medicare and in the private sector; people can receive benefits only after exhausting their assets; the program pays only those costs that the elderly cannot; and service is limited largely to the severely disabled who do not have family supports. Within this system, it would be difficult to obtain large additional savings.
Strategies for Controlling Growth of Medicaid Expenditures for the Elderly: