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

Publication Date: December 2003

Publisher: Library of Congress. Congressional Research Service

Author(s):

Research Area: Health

Type:

Coverage: Indiana

Abstract:

Demographic challenges posed by the growing elderly population and demands for greater public commitment to home and community-based care for persons with disabilities of all ages have drawn the attention of federal and state policymakers for some time. 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 in 2001(almost $152 billion of $1.24 trillion). Federal and state governments accounted for almost two-thirds of all spending. By far, the primary payor 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 in understanding 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, one in a series of 10 state reports, presents background and analysis about long-term care in Indiana.

Indiana is the 14th largest state in the country with 6.1 million people in 2000; about 12.4% of its population is aged 65 and older. The state's oldest population grew quite rapidly during the 1990s -- those aged 85 and older grew by 27.6% from 1990-2000. By 2025, persons aged 65 and older will represent close to one out of five persons, slightly higher than the U.S. average.

Indiana is one of a few states that house most of its long-term care programs for the frail elderly, younger adults with disabilities and persons with developmental disabilities within the same administrative unit. Indiana makes heavy use of institutional services to serve the first two populations. In FY2001, $1.1 billion, or more than 27% of all Medicaid spending, was for care in institutions. Nursing home spending accounted for almost two-thirds of Medicaid long-term care spending; services in intermediate care facilities for the mentally retarded accounted for 23%; and home and community-based services accounted for almost 15%.

Slow-moving waiting lists for home and community-based services have been a problem for the state and quality of care issues caused the state to revamp its primary program for persons with developmental disabilities. The state replaced its former program and implemented new quality assurance mechanisms, including use of routine, independent audits.

This study was funded in part by a grant from the Jewish Healthcare Foundation and by a grant from the U.S. Department of Health and Human Services, Office of Rural Health Policy, Health Resources and Services Administration.