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© 2009 Springer Publishing Company Keywords: home- and community-based services; needed. Without carefully planned, cost-effective options, the deinstitutionalization; waiver; long-term care accelerated growth in the senior population may soon result in an inability to sustain coverage of other Medicaid populations, fund expansions for uninsured populations, or maintain levels of sup- port in other areas of state responsibility. It is not clear that the current, ever-tightening federal regulatory approach to the Medic- aid program facilitates the needed development of new, innovative A Different Approach program models. to Providing Care to Utah’s Nursing Home With the expected rapid Patients in a High-Cost, acceleration in the growth of the age 65+ population and the Dynamic Environment consequent increasing utiliza- tion of high-cost, long-term care Michael Deily, BA services, additional planned and tested options are needed. T he State of Utah foresees a boom in the growth of its senior population over the next 40 years. This increase will poten- tially create more conﬂict between the ﬁnancing of human service programs for seniors and other state priorities (e.g., public This article will address the intersection of the demographics of education, transportation, and corrections). A major concern in Utah’s population with the historical approaches to Medicaid long- this area is the State’s Medicaid program. Medicaid is the major term care coverage. It will describe an alternative model developed payer of long-term care services for the senior population, and in Utah for providing care to nursing home patients that responds at the same time Medicaid is responsible for the ﬁnancing of the to the cost pressures in long-term care and individual preferences health care needs for an increasing number of the lower income in service delivery. It will also describe how Utah has recently been persons. forced to undergo major modiﬁcations as a result of regulatory Compared to Medicare, which pays for 19% of long-term care compliance issues. costs, Medicaid supports nearly half of the total national long-term care expenditures. These dollars constitute about one-third of Med- icaid spending. Despite initiatives diverting individuals to commu- UTAH DEMOGRAPHICS nity-based settings, nationally 63% of ﬁscal year 2005 Medicaid’s long-term care spending went to nursing homes (Georgetown Uni- The aging of the baby boomers in Utah is changing the state’s pop- versity, 2007). This continuing reliance on nursing home care for ulation. In 2004, the Utah’s growth rate of its senior population the delivery of long-term care services may be difﬁcult to sustain started to exceed that of the overall population, and is expected for several reasons; (a) the increase in the age 65+ populations, (b) to continue to do so through 2050 (Ellis & Dodge, 2005). The the expense of nursing home care, and (c) consumer’s apparent projections for the increase in Utah’s age 65 and older population preferences regarding where to receive long-term care. These all are sobering. They indicate a growth of 4,167 people in 2006, point toward a need to decrease the reliance on nursing homes as increasing to an estimated 13,186 in 2020 (Utah Commission on the dominant service provider of such services. Aging, 2006). As a proportion of Utah’s total population, the age Given these issues, states have been working to develop ways to 65+ population will increase from 8.5% in 2000 to a projected provide more ﬂexibility in their long-term care delivery systems. 17.8% in 2050 (Ellis & Dodge, 2005). Additionally, the state is With the expected rapid acceleration in the growth of the age 65+ experiencing a rapid increase in the number of residents turning population and the consequent increasing utilization of high-cost, age 75 and 85. The 85+ population is considered to be the most long-term care services, additional planned and tested options are fragile of the senior population. There will be 55% that require Care Management Journals • Volume 10, Number 3 • 2009 121 DOI: 10.1891/1521-0922.214.171.124 Deily some form of long-term care (Melnyk, 2005). Utah’s age 85+ pop- ulation is predicted to grow from 28,340 in 2006 to 59,470 in 2030, increasing 110%, compared to a national projected growth of 80% (Utah Commission on Aging, 2006). Nationally, Medicaid expendi- While the senior population will increase rapidly in Utah, the tures have grown to a point under age 18 population will remain relatively constant. It will hover just over 31% of Utah’s pop
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