Long-Term Care

A number of health reform provisions give states additional options for financing HCBS services. This brief analyzes scenarios whereby states, which have significant roles in implementing many aspects of the ACA, might implement a combination of new Medicaid state plan options, enhanced Medicaid matching payments, and demonstration projects to expand HCBS care. In determining whether to adopt these options, states will assess whether they improve upon the current Medicaid authorities they use.

What are some of the essential components of Medicaid long-term care programs? This brief, geared towards people working in Medicaid or disability employment, discusses payment for long-term care, range of services, administration, eligibility, functional assessment and rebalancing of long-term care systems. Also find examples of how some states have incorporated aspects of long-term care services and supports (LTSS) into their Medicaid Buy-In (MBI) programs.

The Ask Medicare initiative was developed by CMS to help caregivers navigate challenging issues and find necessary information to make better healthcare decisions for their loved ones. The main feature of Ask Medicare is a one-stop, easy-to-use Web site with targeted information, decision-making resources, and support tools. The Web site also includes a free e-newsletter and instructive, personal stories from caregivers.

Find out about a pilot program at four affordable housing properties for older adults in Washington, DC. With input from service coordinators, residents, and family caregivers, a two-part workshop was designed to increase caregiver capacity while strengthening the coordination between caregivers and service staff. Caregivers who participated in the workshops reported feeling more confident in their roles as well as more knowledgeable of resources.

Review testimony presented at a public hearing in California. Among the recommendations for taking advantage of ACA’s opportunites are state support of the CLASS program, enhancement of care coordination and service integration for vulnerable seniors and people with disabilities including increased access to ADRCs, exploration of the potential to apply for enhanced Medicaid HCBS options, and identification of ways to support and grow the direct care workforce.

Four groups of caregivers discuss their challenges in accessing caregiver services. Challenges include lack of access to internet and phone, cultural traditions which prevent self-identification as caregivers, and unexpected caregiving responsibilities for wounded veterans. Proposed solutions included assistance in navigating government programs, connecting new caregivers to peer mentors and caregiver networks, and an increased focus on assisting the care recipient and the caregiver.

This report is the latest in a series of annual reports that present expenditures data for Medicaid Home and Community-Based Services (HCBS) waivers authorized under Section 1915(c) of the Social Security Act. Table 1 presents reported Federal Fiscal Year (FY) 2009 expenditures for each HCBS waiver in effect during that year. Table 2 presents HCBS waiver expenditures data from FY 2004 through FY 2009 by state. The remaining tables present data according to the populations served in waivers.

Review six fact sheets that compile national figures and provide basic information on some of the most important issues surrounding long-term care. Each 2-3 page document presents a critical long-term care issue, highlighting main points in bullet format and providing a comprehensive list of citations. Topics range from demographics and economic characteristics of the aging population, to who needs, provides and pays for LTC, and where it is provided.

This report is the latest in a series of annual reports on Medicaid long-term care expenditures. Table 1 presents national expenditures data for FY 1997–FY 2009. Tables A through T present state-by-state expenditures data for FY 2004–FY 2009 for specific categories of service. Tables U, V, and W present the distribution of each state’s LTC expenditures among institutional and community-based services.

Experts were asked about the current state of LTC in the US and potential reforms in the delivery and financing of these services. Eight articles appearing in the August 2010 issue of Medical Care Research and Review explore the survey findings and analysis, revealing opinions on the state of the industry, the nature of its problems, its dissatisfaction with past efforts at repair, and its preferences for future strategies for improvement.