Medicaid Nursing Homes

No Wrong Door

In Virginia, there are over one million people age 60 and older and over 90,000 Virginians age 85 and older. These figures will only grow in the upcoming decades.  Thus will put increasing strain on public programs and will require service providers to reorient medical care toward providing continued, high-quality long term care services.  Long term care is of growing importance to health care sector.  Although the aged and disabled populations make up 30% of Virginia’s Medicaid population, these individuals account for 70% of the state’s $4 billion Medicaid budget.

Yet providing long term care to those in need is a confusing a bureaucratic process.  For instance, in Virgina, there are 6 agencies that provide long term care services:

  • The Virginia Department of Health (VDH) oversees licensure and certification for home health agencies, home care organizations, and nursing facilities. VDH also has programs aimed at reducing falls and managing chronic diseases such as diabetes, cardiovascular disease, and arthritis for the elderly and individuals with disabilities.
  • The Virginia Department of Aging (VDA) works with 25 local Area Agencies on Aging (AAA) and other public and private organizations to help older Virginians maintain their independence and avoid inappropriate or unnecessary institutionalization.
  • The Department of Medical Assistance Services (DMAS) funds the majority of long-term support and community based care services provided across the state through Medicaid-funded home and community-based care waivers. Virginia currently operates seven of these waivers.  In Fiscal Year 2004, DMAS provided care to 208,503 aged, blind and disabled beneficiaries at a cost of almost $2.6 billion dollars.
  • The Deparment of Mental Health, Mnetal Retardation, and Substance Abuse Services (DMHMRSAS) is not just a horrible acronym.  The department also works with 40 Community Services Boards (CSBs) to provide mental health and substance abuse services.  DMHMRSAS and the CSBs also directly operate the Mental Retardation and Day Support Medicaid home and community-based waivers.
  • The Department of Rehabilitative Services (DRS) collaborates with the public and private sectors to provide a variety of employment related community services including consumer-directed personal assistance program.
  • The Department of Social Services (DSS) coordinates services with 120 local departments of social services to assist needy individuals.

To summarize, there are 6 state government departments, 120 local DSS, 25 AAA’s, 34 health departments, 16 Centers for Independent Living, 40 local CSBs, as well as faith-based organizations and non-profits.  Each of these organizations provides a different components necessary for quality long-term care.  Additionally, although referral are encouraged, there is no automated system for making these referrals.

According to the Age in Action newsletter, “In 2005, the Virginia General Assembly passed House Joint Resolution Number 657, which requested the Secretary of Health and Human Resources to study the development of a No Wrong Door approach for Virginia’s long-term support service system; it would give providers a more seamless method to share information about an individual for whom they provide services, and would spare applicants the process of answering the same questions over and over again.”  Allowing aged and disabled individuals to access the care they need however they enter the social services system would streamline benefits processing and improve beneficiary quality of life.

One of the efforts Virginia has come up with is, which connects seniors with a variety of community resources.  Virginia already has a No Wrong Door system for its children’s health insurance under the Family Access to Medical Insurance Security (FAMIS) Plan.  Other states, such as Ohio, have also implemented their own No Wrong Door systems.  Additional streamlining of services and coordination between the public and private sector is necessary in order for the No Wrong Door initiatives to decrease cost and improve beneficiary quality of life.

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