New Medicaid feature to reduce future nursing home enrollees

HARRISBURG » Years in the making, Democratic Gov. Tom Wolf’s administration is rolling out a new Medicaid feature that’s designed to reduce the future number of enrollees in nursing homes and, along with it, a fast-growing expense in a state where the elderly population is exploding.

The program takes effect Jan. 1 in 14 southwestern counties. A launch is planned in 2019 for Philadelphia and its four collar suburban counties and in 2020 for the remaining 48 counties across central and northern Pennsylvania.

It is perhaps the biggest change in Pennsylvania’s $30 billion Medicaid program since 2015, when income eligibility guidelines expanded at the close of Republican Gov. Tom Corbett’s administration to include hundreds of thousands of low-income adults.

This shift means insurers will be paid to manage Medicaid’s long-term care services, with a financial incentive to get enrollees the nursing care and services they need in a home, where it is half as expensive as a nursing home.

“Long term, you are expecting to see savings because you are going to be seeing more people getting services in a less expensive environment, which also happens to be where people want to get their services, at their home,” said Teresa Miller, Wolf’s acting human services secretary.

The cost difference is significant, as it’s roughly $62,000 per year for nursing home care and half that for skilled nursing care at home, state officials say. State officials expect this to slow the growth of the state’s Medicaid-covered daily nursing home population of more than 50,000.

Few people may actually move out of nursing homes as a result of this shift. Often, just finding a place to live for someone who has made a nursing home their home is a complicated task.

What is more likely is that the system will help someone stay in their home longer when they have a health complication that requires more attention, said Richard Edley, executive director of the Rehabilitation and Community Providers Association, which represents agencies that work with the disabled.

The drive to save money on care for the elderly comes as the number of adults 65 and older in Pennsylvania is expected to grow by a third over the next decade while the number of working-age residents shrinks.