Nebraska's long term care services and financing system perform better than the rest of the states. The state has been also credited for taking lead of strategic and effective long term care solutions that other states might follow in the future.
The Good Side
Nebraska has the lowest Medicaid dependency in the country. In 2002, Medicaid spending in the state was only 52.8 percent compared to the nationwide average of 66.7 percent. This can help lessen the financial constraints on Medicaid, and all the cut-down expenses can provide more decent health care services and facilities to the less fortunate.
The state also prides of having the highest market penetration for private long term care insurance in America. Since residents are able to avail private long-term care insurance, this means a greater deduction on Medicaid expenditures throughout the state.
In other states, residents have no option but resort to costly institutionalized care (nursing care or assisted living), although most of them want to stay in their homes as much as possible. Nebraska has improved this problem by providing residents with alternative care in the community. In fact, the average monthly nursing facility residents dropped from 8,742 in 1996 to 7,872 in 2003. On the other hand, in the same period, recipients of home and community-based care greatly increased from 600 to 4,200.
With these reforms, Nebraska greeted the rewards of strong long-term care system: low Medicaid census and reimbursement rate and rare cases of liability suits. Most recipients were satisfied with the LTC services provided by the state, with no difference from what received in Medicaid and private insurance companies. More seniors own their homes than ranks Nebraska as the 22th state with high home ownership by the elderly. Home equity can ensure better long term care for seniors who can't otherwise afford private insurance.
The Challenges
However, it is inevitable for the state to endure demographic and long-term care challenges. Nebraska is the second state with the highest percentage of people age 65 and above residing in nursing facilities. The age group most likely need long term care will increase from 1.5 percent to 1.9 between 2000 and 2020 in the United States. Meanwhile, Nebraska may increase from 2 percent to 2.7 percent.
The labor shortage in home and community-based settings in rural areas posed problems in Nebraska. Long term care providers and home health agencies, as well as low-wage workers, find it hard to compete with other businesses and industries.
Although Nebraska received the lowest Medicaid dependency rate in 2002, the percentage of nursing home residents dependent on Medicaid is growing in number. This is quite disturbing because a very small addition in the nursing home occupancy rates affects the Medicaid budget. Several problems have crept in despite the state's effort in strengthening home and community-based services. The relocation of recipients into community-based services is almost impossible because those staying in nursing home facilities are the most frail or impaired.
Nebraska Long Term Care Partnership Program
Nebraska pursued some budget cuts and raised taxes to relieve financial stress. After the Deficit Reduction Act of 2005 was implemented, the state adopted the Long Term Care Insurance Partnership Program not only to meet the requirements of DFA but to end the troubling effects of long term care in the financial system. Under LB 965 in 2006, the Nebraska's Long Term Care Insurance Partnership authorizes the state and private insurance providers to grant policyholders with special privileges such as Medicaid's asset protection or recovery, inflation protection, and tax deductions.
