Long-Term Care

This topic paper summarizes how states can use Medicaid to pay for most institutional transition program costs on a permanent basis as a result of policy change since 2000. It also describes how states are currently using Medicaid HCBS Waivers to pay for community transition services-temporary supports people need when trying to move such as housing deposits, utility set-up fees, and furniture.

This brief focuses on one consumer-direction model within the Family Care program-the Agency with Choice model-in which a \"co-employment agency\" serves as the Employer of Records and the consumer acts as the Managing Employer. In the other consumer-directed model, the consumer takes on all employer responsibilities. Slightly more than one in five Family Care members choose the co employment option, demonstrating how a managed care program can incorporate consumer direction.

Kansas operates four Medicaid waivers that allow program participants to self-direct their care. These programs permit participants to hire a worker or their choice and choose an organization to act as the Employer of Records for their worker. The programs are noteworthy because of the large number and wide variety of organizations that fulfill this function and the many different ways in which they serve their clients, providing a high level of choice to participants and their representatives.

In 2001, the State of New Jersey was awarded an Administration on Aging grant as part of the National Family Caregiver Support Program (NFCSP). New Jersey’s project involved integrating a focus on caregiving into the existing long-term care system. The project included activities aimed to better identify caregivers and their unique needs and increase awareness among senior service staff of diverse caregiving situations.

Discusses options for combining Medicaid long-term care funding and expanding the scope of long-term care services. The call was organized in response to a need identified by a grantee and included states that were available and had relevant experience with the questions being raised.

Case study reports on programs in 9 states that received federal Nursing Home Transition Grants from 1998 - 2000 are now available. New reports describe programs, implementation, and lessons learned from transition programs in Arkansas, Florida, New Jersey, Pennsylvania, Texas, Vermont, Michigan, Wisconsin and from a hospital to nursing home diversion program in Colorado.

Ohio has been using its Real Choice Systems Change grant to bring people together to consider options to streamline access to information about long term services. A group of county, municipal and private organizations in Ohio are working with state agencies to develop a pilot project. On December 13-14, 2004, policy experts from Rutgers Center for State Health Policy and the National Academy for State Health Policy met with stakeholders to provide information and technical assistance.

States that are trying to streamline policies and paperwork to help people receive long term care and support in community settings are re-examining the processes they use to determine eligibility for programs. This technical assistance document focuses on one of those processes, determining “level of care”, and provides clarification about federal requirements for physician involvement.

This technical assistance document is the first in a series of papers that examines issues pertaining to respite services as part of the Medicaid program. By reviewing the prevalent definitions of respite in the published literature and federal documents, we seek a consistent view of respite services that can be used in the development of administrative policies to support respite for Medicaid HCBS beneficiaries and their informal caregivers.

This issue brief will present several approaches that attempt to tackle the underlying challenge of reducing nursing facility utilization and expenditures. These range from modifying the nursing facility reimbursement methodology; to converting nursing facilities to assisted living centers, paying nursing facilities to take beds off-line, and using capitated managed long-term care; to approaches with theoretical promise that have yet to be adopted in any state.