Eligibility

Medicaid program integrity is among the highest priorities of the nation’s Medicaid Directors and is a key component of every initiative and program states conduct. Program integrity is about creating a culture where there are consistent incentives to provide better health outcomes within a context that avoids over-or underutilization of services. Directors seek to promote economy, efficiency, accountability, and integrity in the management and delivery of services.

Have you seen the new site sponsored by CMS? This space offers a resource center for states, up to date information about the affordable care act and additional federal policy guidance. The waiver section organizes information by state, program name, waiver authority and status of a application. This chart gives an overview of the four primary types of waivers and demonstration projects: Section 1115, Section 1915(b) Managed Care, Section 1915(c) HCBS, and Concurrent Section 1915(b) and 1915(c).

State Medicaid agencies fund supports & services for individuals with disabilities. As national public policy recognizes & emphasizes the ability of individuals with disabilities to work, states are integrating employment supports into the continuum of long-term care in Medicaid. This brief discusses federal legislative & regulatory framework for funding employment supports in Medicaid, highlights examples of state innovations & best practices to promote positive employment outcomes.

In its first year of operation, the Center for Medicare and Medicaid Innovation has a long list of accomplishments, yet some observers express concern that its fast-paced approach may be overwhelming to smaller delivery systems. A status report of the Innovation Center’s activities to date is provided, including delineating the goals envisioned by Congress, detailing the new tools it was given, and emphasizing how the enhanced authority compares with CMS’ traditional demonstration programs.

Overview provided about individuals and families who can be expected to receive assistance under insurance affordability programs, which include Medicaid, CHIP, advance premium tax credits and cost-sharing reductions, and Basic Health Programs. Particular focus is placed on the characteristics of individuals whose incomes place them at or near the Medicaid/exchange dividing line. The authors identify opportunities for greater collaboration and alignment in key areas.

Despite decades of increases in program participation and spending, the disability support infrastructure in the United States and the economic independence of people with disabilities have eroded. Rather than tighten eligibility or reduce program benefits, this issue brief proposes gradual programmatic reforms and evidence-based structural changes to improve the economic status of Americans with disabilities.

Many states are undergoing long-term services & supports (LTSS) transformations. The lagging economy & increased demand for publicly funded LTSS are placing pressure on state policymakers to find solutions. As a result, many states either have or plan to implement Medicaid Managed LTSS, with 12 states having existing programs & another 11 with plans for implementation. Many states used the economic downturn as an opportunity to balance services from institutional to non-institutional settings.

Organizations are assisted in enrolling seniors & younger adults with disabilities with limited means into the benefits programs for which they are eligible so that they can remain healthy & improve the quality of their lives. New features available on the site include fact sheets with detailed info about core benefits programs, a clearinghouse of promising practices, & a library of sample benefits outreach materials, webinar slides, & publications—all searchable by topic, state, & keyword.

Despite continued fiscal pressures on states, eligibility policies remained stable in nearly all state Medicaid and Children's Health Insurance Programs during 2011. Moreover, many states used technology to increase program efficiency and streamline enrollment. The "maintenance of eligibility" requirement in the Affordable Care Act (ACA) played a key role in preserving coverage levels. Without it, more states likely would have limited eligibility or tightened enrollment procedures.

Existing national disability-related survey & administrative data are limited in their ability to meet needs of federal programs & policy makers. One potential response to these shortcomings is the fielding of a national disability survey. This report was prepared to assess the need for developing & fielding another national disability survey data collection effort. It presents findings from one of the project’s major activities designed to review the disability-related information.