Long-Term Care

This memorandum presents data on Medicaid long-term care expenditures in Federal Fiscal Year 2005 (Sept 2004-Sept 2005). The accompanying tables present data on Medicaid Expenditures for Long-Term Care services from 1993-2005. Data included for Nursing Homes, ICF-MR, Personal Care, HCBS Waivers, Home Health, Home Care, Inpatient Hospital Care, Inpatient DSH, Inpatient Mental Health, Mental Health DSH, Medicaid Managed-Care, Prescribed Drugs, Long-term Care, Targeted Case Management and PACE.

A few recent Medicaid initiatives have emerged that take the program into new directions. States have a number of objectives in developing these approaches, including offering beneficiaries greater choice, promoting personal responsibility and healthier behaviors among enrollees, and looking at the private marketplace. This brief examines how these approaches change financial risk and responsibility for states, the federal government, beneficiaries and providers.

This publication summarizes and synthesizes some of the most important things that research and demonstration programs have learned about consumer direction. The paper provides leaders and practitioners with a common framework of understanding for our next challenge: To build upon current knowledge and to make “consumer direction” an integral part of the options available for all older persons who may need long-term care. Read the 12 common consumer direction myths and then learn the reality.

This report outlines the efforts of the State’s Department of Disabilities, Aging & Independent Living to create a balanced system of care for elders and adults with disabilities. It discusses the Department’s successes and obstacles in increasing home and community-based services, including respite care and consumer-directed services for care recipients and caregivers, and shifting away from institutionalized care. It also outlines the services of the five Area Agencies on Aging offices.

The manual is a nursing home to community discharge planning manual designed primarily for use in nursing homes and may be of help to others to use in developing manuals for their communities. It is designed to orient the long-term care providers to the nursing home discharge process by defining the roles of the key partners who are involved in returning residents to community living and to document a standard protocol for accessing and maximizing partner resources.

This Executive Summary and accompanying Abbreviated State Reports encapsulates the comprehensive case studies that Congress directed CMS to perform as a first year task in a 3-year study of state management practices in balancing long-term care systems. The studies were undertaken in 8 states (AR, FL, MN, NM, PA, TX, VT, WA) and examine “rebalancing” from a qualitative and quantitative perspective.

The State of Vermont was seeking proposals from individuals or organizations interested in becoming the Medication Assistance Consultant. The deadline for submission of proposals was June 23, 2006. This RFP serves as a great example when seeking out contract work.

To improve long-term care quality, state and federal policymakers are experimenting with positive incentives to reward providers who can demonstrate better quality. Incentive payment systems are part of a broader trend in the health care field, referred to as “pay-for-performance” and may consist of either financial payments or non-financial recognition. This paper describes the challenges involved in designing effective quality incentive payment systems in the long-term care sector.

A new fact sheet and report analysis Medicaid spending and enrollment trends for 2000-2004. Medicaid trends are related to the state of the nation's economy; as the economy has strengthened, increases in enrollment and spending have slowed. Rising enrollment and health care inflation produced most of Medicaid's spending increases. Even with a stronger economy, however, Medicaid's enrollment pressures remain due to demographic trends and continued declines in employer-sponsored insurance.

This article draws on the best practices of consumer-driven health programs for people with disabilities, and offers a Disability-Competent Health System model. The model integrates health and social services to maximize opportunities for independent living and person-centered care. This interdisciplinary approach is a promising framework and an opportunity for the independent living movement to address health-related issues without subscribing to the medical model.