Agenda - 09-06-1983 - Laserfiche WebLink

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Administration. The largest expenditures are under Medicare, a program authorized by Title XVIII of the Social Security Act that provides broad health insurance coverage for most people who are 65 or older and for some disabled people. An estimated $1,146 billion was spent in fiscal year 1982 on Medicare benefit payments for home health services, a sharp increase over the $287 million spent in fiscal 1976. Some of the growth in expenditures is the result of increased use---the number of home health visits reimbursed under Medicare has doubled over the past 10 years although present law continues to be biased toward institutionalization. (5). Medicaid i a federal and state program authorized by Title XIX of the Social Security Act, through which the Federal Government pays from 50 to 78 percent of the state costs of providing health services to the poor. It also Covers home health services. Nationwide, the number of recipients of these services increased from 109.900 in 1973 to 358.400 in 1979, more than a threefold increase. Expenditures rose from $25. 4 million in 1973 to $263.6 million in 1979. Two other programs that cover some variation of home health care include Title XX, which spent $530 million in Ifiscal 1978 on home—delivered services to the economically needy. and Title III of the Older Americans Act, which spent approximately $43 million in fiscal 1980 on home—based services to the elderly. (5) In spite of' the growth in expenditures and participation in home—based serviCes, there is expanding support for increasing coverage to eligible individuals not currently receiving such services. Also, because individuals with long—term—care needs may require a range of economic, social, mental health, and medical services, there is interest in adding services to those currently covered by federal programs. Support for these changes comes from the belief that there are major gaps in the current health care system and also that additional resources will be necessary to meet the demands of a growing elderly population. The number of North Carolinians aged 65 and older grew from about 300.000 in 1960 to 600.000 in 1980, and is expected to increase to about one million by the year 2000. The proportion of elderly in the population also increased from about 7 percent in 1960 to more than 10 percent in 1980, and is expected to exceed 13 percent by the year 20004, The largest percentage increase in the population of the elderly has occurred among people 75 and older. The largest growth in this age group has been among women: many of whom are widows living alone, and needing some help from families, friends or community agencies in orderl to maintain their independence. 1 Iba-Esalualal_lar414usiog_Ionii:Olgoml_Esotogiiucts While expandplg in home care services is considered to be a way of meeting the needs' of a growing older population, it is also seen as a way of helping some chronically ill elderly avoid or postpone nursing home or hospital 'care. Because of the high cost of these institutional services, reduction in their use could produce substantial savings. In North Carolina, fetal expenditures for hospital care, for example, 6