"Why should state Medicaid agencies get involved with DSW initiatives?"

Medicaid long term care spending doubled between 1987 and 1997, and is expected to continue to increase dramatically along with the number of older Americans. Long term care spending, including both institutional and home and community based services, accounted for an average of 35% of state Medicaid budgets, with some states spending 50-60% of their Medicaid budgets on long term services and supports. Provision of services in the community holds the potential to both increase the quality of life for Medicaid recipients and save Medicaid dollars. Appropriate and timely provision of home and community based services can delay or prevent institutionalization, keeping long term care costs lower.Inadequate or unsuitable home and community based services, or a lack of access to the services, can lead to inappropriate institutionalization, more visits to the emergency room, and an increased need for expensive acute care. Access to adequate community based supports depends on the availability of a well trained workforce of sufficient size. Obstacles to achieving such a workforce – including worker shortages, lack of training, lack of supervision, and high turnover – exist in many regions. The impact of workforce issues on the quality of service is direct and immediate. For example, turnover of direct service workers reduces continuity of care for the consumer as the new service provider establishes a relationship and climbs the learning curve. Workforce issues also increase costs for providers, who in turn pass them on to third party payers like state Medicaid Agencies. For example, researchers estimate the cost of turnover in long term care for government payers at roughly $2.5 billion, not including the increased health care costs created by lower quality care for consumers and increased injuries among workers. State Medicaid agencies play a key role in quality assurance, worker and supervisor education, wages and benefits, and provider reimbursement. Their interventions in this area can have a real impact on both Medicaid spending and the quality of care.