ARIZONA
Arizona has been expanding home and community-based services (HCBS) in recent years as a proportion of its overall long-term care system but, like many other states, Arizona also is feeling the fiscal pressures of providing HCBS services for growing numbers of people with disabilities.
Home and Community-Based Services
During the 1990s, Arizona's population grew by more than 42 percent. The number of Arizonans age 65 and older increased by 39.5 percent between 1990 and 2000, compared with a national average of 12.4 percent. In her January 2003 budget message, Governor Janet Napolitano said that Arizona was currently taking in the same level of revenues that the state had collected in FY 1999, but it was serving 300,000 more participants in its Arizona Health Care Cost Containment System (AHCCCS), which includes its long-term care program.
Total AHCCCS enrollment as of April 1, 2003, was about 905,000. Of this total, almost 37,000 persons were enrolled in the Arizona Long Term Care System (ALTCS). That number had been 34,334 people in June 2002.
Planning and Reports
Arizona issued a long-term care Olmstead planning report in September 2001 that was the combined effort of the Arizona Health Care Cost Containment System (AHCCCS) and the departments of Human Services and Economic Security. Revised work plans for the goals identified in the report were issued in March 2003. Labor force shortages had been addressed in the report, for example, with proposals such as using Medicaid funds to pay spouses and parents as personal care attendants. Although AHCCCS requested approval for that initiative from the Centers for Medicare and Medicaid, that request was denied. However, the Division of Developmental Disabilities (Department of Economic Security) held a roundtable discussion on increasing the network of providers in January 2002. Four priority strategies were developed through this process. The Arizona Legislature approved an allocation to increase rates of providers who were receiving below average negotiated rates, beginning July 2002.
To address the goal of finding providers with an interest in and skills for serving people with serious behavior problems, the Division of Developmental Disabilities implemented a Community Protection Project to increase the focus of placing individuals with significant behavior challenges into the community. Beginning in August 2002, the division initiated new behavioral health services designed to support individuals in the community and reduce or prevent inpatient placements.
The third biennial Community Based Services and Settings Report was released in May 2002. The report is a collaborative effort by the Arizona Health Care Cost Containment System, the Department of Economic Security, and the Department of Health Services. The report noted that the percentage of members of the Arizona Long-Term Care System residing in a nursing facility had declined from 58.8 percent in 1998 to 46.6 percent as of January 2002. The proportion of members living in their own homes had increased from 35.9 percent to 40.8 percent during that same period.
In 2000, Arizona began surveying participants in the ALTCS to evaluate consumer satisfaction with the program, known as the Long Term-Care Project. Also that year, the state awarded three contracts to health plans to provide long-term care services in Maricopa County. In the third phase of the Long-Term Care Project, the state surveyed consumers after they had been given the choice to switch among the three plans to see what, if anything, had changed with their satisfaction levels. Comparisons were made between members who remained with their current health plans and those who switched to another plan.
The report, Now and the Next Generation: Long-Term Care 2002, found that consumers in Maricopa County were "extremely satisfied" with their long-term care services, whether or not they had changed health plans. The report noted that more research was needed to determine how much difference choice makes, why new consumers choose one plan over another, and why consumers choose to remain or not remain with their existing plan.
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