Long-Term Care

Developing home & community-based service (HCBS) alternatives to institutional care has been a priority for many state Medicaid programs over the last three decades. While the majority of Medicaid long-term care dollars still go toward institutional care, the national percentage of Medicaid spending on HCBS has more than doubled from 19% in 1995 to 43% in 2008. More than 3 million people were served by Medicaid HCBS programs in 2008 and hundreds of thousands of people are on waiting lists.

A new technical assistance brief from the Center for Health Care Strategies provides a brief outline of the Money Follows the Person, Balanced Incentives Payment Program, the Community First Choice Option, and the modified Home and Community-Based State Plan option. For each program, the authors outline the budget impact/FMAP opportunity, application process, participant eligibility, care coordination/plans, and data reporting/evaluation.

In an effort to improve care & reduce costs, states & the federal government are seeking new ways to provide services to people eligible for both Medicare & Medicaid. Missing from the discourse are the voices of these dual eligibles. Changes to the way their care is organized & delivered could have profound effects on their health, quality of life, & satisfaction. This project aims to complement state & federal efforts by offering perspectives on what duals want from their models of care.

The MO HealthNet Division administers the MFP program called My Life, My Way, My Community. This site is an example of how this state presents material to the community about the program. See samples of the Initial Application, Operational Protocol, Brochure and Participation Agreement.

The Centers for Medicare and Medicaid Services (CMS) requires that quality of life surveys be conducted for Money Follows the Person participants transitioning from habilitation centers and nursing facilities into the community. Review this survey as a potential template for your MFP program. This website recruits potential surveyor applicants and offers a sample Surveyor Letter, Application, Confidentiality Statement, Screening and Vendor Input Form.

These Guiding Principles were developed to help to preserve the rights of individuals under participant direction, no matter what form or model, if and when workers choose to form a union. The NRCPDS cover letter, Guiding Principles, and NRCPDS Director Kevin Mahoney's signing ceremony remarks are available here.

This paper provides recommendations on changes to improve delivery of the Qualified Medicare Beneficiary (QMB) program so that it can more fully serve the purposes for which the program was established. It is the last in a series of four papers that highlight pressing issues facing dual eligibles and provide recommendations to the federal Medicare-Medicaid Coordination Office (MMCO), state Medicaid agencies and other interested policymakers and stakeholders on how to address them.

The Centers for Medicare & Medicaid Services, along with Mission Analytics Group & Human Services Research Institute, created an implementation manual for the Balancing Incentive Program. The Program encourages states to increase the percentage of long-term care dollars going to home & community-based services through making additional Federal Medical Assistance Percentages available to States that are currently lower performing. This manual aims to help States make the most of this Program.

This survey contains daily private-pay rates for private & semi-private rooms in licensed nursing homes, monthly base rates for assisted living communities, hourly rates for home health aides from licensed agencies & agency-provided homemaker companion services, & daily rates for adult day services across the US. Costs for this survey were calculated for each service provider in an area & were aggregated across all providers to compute a statewide average cost.

Medicaid officials in every state are enacting a variety of cost cutting measures as states’ spending is projected to increase 28.7% in FY2012 to make up for the loss of federal stimulus money. The survey finds cost containment actions ranging from restrictions on payments to providers & benefits, to new copayments for beneficiaries & additional efforts to contain the costs of prescription drugs. States are also trying to make their programs more efficient through a number of procedures.