A CRS Review of 10 States: Home and Community-Based Services -- States Seek to Change the Face of Long-Term Care: Pennsylvania

Publication Date: April 2003

Publisher: Library of Congress. Congressional Research Service

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Demographic challenges posed by the growing elderly population and demands for greater public commitment to home and community-based care for persons with disabilities have drawn the attention of federal and state policymakers. Spending on long-term care by both the public and private sectors is significant. In 2001, spending for long-term care services for persons of all ages represented 12.2% of all personal health care spending (almost $152 billion of $1.24 trillion). Federal and state governments accounted for almost two-thirds of all spending. By far, the primary payer for long-term care is the federal-state Medicaid program, which paid for almost half of all long-term care spending in 2001.

Many states have devoted significant efforts to respond to the desire for home and community-based care for persons with disabilities and their families. Nevertheless, financing of nursing home care, chiefly by Medicaid, still dominates most states' spending for long-term care today. To assist Congress understand issues that states face in providing long-term care services, the Congressional Research Service (CRS) undertook a study of 10 states in 2002. This report, the first in the series of ten state reports, presents background and analysis about long-term care in Pennsylvania.

Long-term care issues have high prominence among state officials in Pennsylvania as a result of its large elderly population and concern about the impact of long-term care costs on the state's budget. Its population aged 65 and older is 15.6% of its total population, ranking second only to Florida. By 2025, 21% of its population will be 65 and older. Pennsylvania federal and state Medicaid spending for long-term care in FY2001 was $5.1 billion ? almost half of all Medicaid spending. Spending for nursing homes was more than one-third of Medicaid spending. While spending for home and community-based services has increased dramatically in recent years, these services represented less than one of every five dollars spent on long-term care in FY2001.

Over the last 2 decades, Pennsylvania has documented issues it has confronted in providing long-term care services. Among these issues are: an imbalance in financing favoring institutional care, rather than home and community-based care (which most people prefer); fragmentation in the management and delivery of services; difficult access to services, especially for low and moderate income persons who do not qualify for Medicaid; and disparities in service availability across the state and populations in need of care. According to state officials, Pennsylvania's guiding principles in long-term care are to: control surplus growth of nursing home beds; support consumer choice; encourage expansion of home and community-based services; fund services rather than capital construction; and assure quality of care.

The 10-state study was funded in part by grants from the Jewish Healthcare Foundation and the U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Rural Health Policy.