Long-Term Care

An overview of Cash & Counseling including a historical context, the theoretical framework for evaluation, and information on design.

This article describes existing personal assistance service programs as well as information on the Cash & Counseling demonstration and evaluation. The program evaluation, including program design, technical assistance, and selection criteria, is discussed.

This presentation provides an overview of the Cash & Counseling design and research results.

One of the greatest challenges, and greatest hopes, for consumer direction as a service option is to integrate this approach into existing case-managed programs. This chapter was part of Consumer Voice and Choice in Long-Term Care and it explores the issues faced when consumer direction and case management are integrated.

States are increasingly interested in the individual budget model for older Medicaid beneficiaries as a mechanism to improve responsiveness of benefits to beneficiaries’ needs and preferences and to increase their ability to remain outside or leave nursing homes. This report describes 10 operating individual budget model programs that serve older persons and identifies four areas of program design that are of particular importance to the success of the individual budget model.

This report and tables present Medicaid 1915(c) Home and Community-Based Services (HCBS) Waiver expenditures data from Federal Fiscal Years 2003 through 2008. Each HCBS waiver is classified by population served in order to show the distribution of expenditures across long-term care populations. This report includes new target population categories to identify waivers that target particular developmental disabilities such as intellectual disabilities and autism spectrum disorders.

This report presents Medicaid long-term care expenditures data in Federal Fiscal Year 2008 (Oct 2007 - Sept 2008). Table 1 shows national data from 1996 - 2008. Other tables present state-by-state data for nursing homes, ICF/MR, state plan personal care, state plan home health, 1915(c) waivers, 1115 waivers that provide HCBS, and other Medicaid services.

This report focuses on creating a more balanced delivery system by expanding home and community-based services and reducing reliance on institutional care where possible is a major goal for virtually all states and the Centers for Medicare & Medicaid Services. The paper concludes by summarizing initiatives and drawing implications for the future financing of home and community-based services.

The proportion of long-term care spending that goes to institutional care has been dropping over time, from 81 percent in 1995 to 63 percent in 2005. However, there remains significant concern that many people who would prefer to receive care in the community are unable to do so because of what has been termed the ‘institutional bias’ of Medicaid. This report discusses the issues surrounding efforts underway to shift the balance toward HCBS in the state of Pennsylvania.

As part of Research on Program Management Techniques by States to Rebalance their Long Term Care Systems, Final Case Studies were conducted in each State for the time period ending December 2007. These Case Studies focus particularly on the reflections of State government officials on rebalancing goals, accomplishments, and next steps as they reflect on all the State’s experiences in moving towards more community-based services.