Long-Term Care

A final rule that would allow more Medicaid beneficiaries to be in charge of their own personal assistance services, including personal care services, instead of having those services directed by an agency, was published in the Oct 3, 2008 Federal Register. The rule, effective Nov. 3, 2008, guides states that wish to allow beneficiaries who need help with activities of daily living to hire, direct, train or fire their own personal care, workers including qualified family members.

Direct care worker (DCW) training and education are challenging issues in all states. Iowa set up a taskforce to review existing requirements, streamline the process of training and education, and to establish a DCW registry by expanding the Iowa Nurse Aide Registry. The taskforce recommends classifying DCWs by function (rather than setting or population served) and developing a governing body, a single approved curriculum, and a certification system for all DCWs.

This report offers recommendations to increase opportunities for people with disabilities to become fully involved in the economic mainstream of society. It presents research findings in key areas such as education and health care. It also describes selected state-level innovations affecting asset development and wealth accumulation. Finally, the report makes policy recommendations for securing meaningful employment, career advancement, and benefits needed for daily living and accommodations.

This paper examines the use of research, demonstration, and program waivers as vehicles for innovation in the delivery and payment of health care and long-term care. It summarizes the context of the creation of the programs and reviews their legal underpinnings. It also analyzes the dynamics between state and federal authorities. Finally, the paper examines the impact of the Deficit Reduction Act of 2005 on the need for or desirability of waivers.

This presentation summarizes the role of regional coalitions of multiple stakeholder groups in redesigning Wisconsin’s employment and long-term care systems. Stakeholders are the intended audience.

Wisconsin used MIG funds to increase self-directed supports within a managed care framework in their state. Find here a set of policy recommendations used for setting the stage for this effort as well as a qualitative study outlining the implementation process. There are also several presentations focused on training support workers to understand and facilitate self-direction, using Cash & Counseling to support employment, and helping people with traumatic brain injuries return to work.

This memorandum and tables present data on Medicaid 1915(c) Home and Community-Based Services (HCBS) waiver expenditures from Federal Fiscal Years 2002 through 2007. Each HCBS waiver is classified by population served in order to show the distribution of HCBS waiver expenditures across long term care populations.

This memorandum presents data on Medicaid long-term care expenditures in Federal Fiscal Year 2007 (Oct 2006-Sept 2007). Table 1 presents national data on Medicaid expenditures for Long-Term Care from 1995-2007. Other tables present state-by-state data for Nursing Homes, ICF/MR, Personal Care, HCBS Waivers, Home Health, Home Care, 1115 Waivers focused on HCBS, and other Medicaid services.

This report and executive summary were completed for Project BRIDGE, an Integrating Long-Term Supports with Affordable Housing grant from CMS. Individuals with disabilities desiring to live independently in Mississippi are hindered by the state’s scarcity of both affordable, accessible housing and the community-based services. The report outlines the issues and offers recommendations for creating community housing arrangements. Review the policy, program and research suggestions.

This publication provides a summary overview of the accomplishments and enduring changes brought about by all of the Systems Change NFT Grantees Despite bringing about many enduring systems improvements, Grantees reported that many transition barriers remain. Grantees made recommendations to help states address continuing barriers to nursing facility transition and diversion so that no one need live in a nursing home simply because sufficient community services and supports are unavailable.