Long-Term Care

Despite the current budget climate that has dampened the pace of some rebalancing efforts, 32 states expanded Medicaid long-term services and supports in FY 2010 (primarily expanding HCBS programs) and 32 states planned expansions for FY2011. This updated fact sheet provides an overview of long-term care services, delivery of such services, and the large role Medicaid plays in financing long-term care.

A large proportion of the population is facing the competing demands of working and caring for a loved one. This study investigates the impact of informal caregiving, employment, and the combination of these responsibilities on the overall well-being of the caregiver. Higher well-being reported by employed caregivers compared with non-employed counterparts suggests that the benefits of employment, such as financial security and social support, can ease the burden of the caregiving role.

Two studies examine the need for HCBS services and the economic profiles of adults with disabilities in MA. The main study examines the unmet needs of adults age 18-59 with disabilities, and the caregiver study focuses on the perspective of informal caregivers, i.e., their unmet needs and those of the people for whom they provide care. A detailed description of the survey methodology and exact criteria for selection into the study is included, as well as copies of the surveys.

Practices featured in the profiles on PHI’s resource website are based on care organizations throughout the country and exemplify their “quality care through quality jobs” philosophy. For most of the organizations, the improved job quality can be directly linked to higher recruitment and retention among direct-care staff. Important elements of the practice, measurable outcomes, and lessons learned are discussed.

Hiring relatives as caregivers remains a controversial policy issue. This two-state case study reports findings about views from policy experts regarding a policy option to hire family caregivers in HCBS long-term care programs. Policy makers also discussed information needed by other states considering this option and effective approaches to disseminate findings about this option from the Cash & Counseling Demonstration Evaluation.

The MFP/Community Reintegration Program is part of a statewide, multi-department demonstration program with the goal of increasing the use of HCBS long-term care services and eliminating barriers that prevent or restrict flexible use of Medicaid funds for necessary services in settings reflecting individual choice. Their website includes outreach materials, program descriptions and qualifications, and numerous related links.

States play among the most critical roles in responding to and ameliorating disability unemployment. Find examples of state policy related to disabilities, a selection of state programs and initiatives, descriptions of select federal policy, and primary source documents. Topics covered include housing, employment, community integration, long-term care, health, disability awareness and benefits counseling.

Presentations from NASHP's 23rd annual conference held October 4-6 in New Orleans are available online. Included are remarks from CMS Administrator Donald Berwick , and presentations such as Health Care Reform: New Options for Rebalancing Long Term Services and Supports, Integrating Care for Dual Eligibles, Reforming State Long Term Services and Supports Programs through Participant Direction, and numerous others. Review the presentations about vital issues in state health policy.

How does ACA provide new financial incentives for states, and create opportunities within existing programs to promote Medicaid HCBS for older persons and adults with disabilities? The number and variety of new options, combined with the prospect of additional federal funds, may give some states added flexibility in balancing their LTC system. Read this fact sheet which enumerates the new programs and modifications to existing ones.

Medicaid finances nearly half of all LTSS spending. Review an update to existing data on Medicaid financial eligibility standards for nursing home and HCBS waiver services for older persons and adults with disability. 2009 data were obtained on state selection of optional pathways for eligibility, income and asset standards, cost-sharing and other post-eligibility financial requirements. A copy of the survey instrument and accompanying letter to state Medicaid Directors are included.