Long-Term Care

A growing number of states are turning to managed long-term care in their Medicaid programs for younger adults and elderly people with disabilities, including those with Alzheimer’s disease and other forms of dementia. This issue brief describes how two states, Massachusetts and Wisconsin, have addressed the special needs of beneficiaries with dementia in the design of their programs and makes policy recommendations for states that are considering implementing or modifying programs.

One of the greatest challenges facing every state Medicaid program is devising an appropriate and effective delivery system for its most resource-intensive beneficiaries. Several pilot programs called Disability Care Coordination Organizations are taking the best attributes of managed care and reconfiguring them to improve the lives of Medicaid beneficiaries with disabilities. This paper synthesizes the programs’ key components and describes the challenges they face.

The CMS Systems Change conference, Transforming Systems: Keys to Success was held April 10-12 in Baltimore. Presentations from the 2006 sessions are available in both PDF and text formats. Topics range from ideas on system transformation, stakeholder involvement, coalition building, strategic planning, sustaining systems change, and the Deficit Reduction Act. Full titles are listed in the keywords section.

Coordinated care organizations (CCO) are an emerging person-centered health delivery system for community-based Medicaid adults with disabilities or complex chronic disease. This report develops recommendations on how states can support CCOs. The recommendations are drawn from visits to seven pilot programs in NC, MN, MA, NY, VT, WI. This report reviews the challenges the CCOs encounter in measuring quality and offers a comprehensive approach for developing an actionable measurement set.

This report draws on interviews with Medicaid care planners for insight into the issues that arise in establishing programs to move individuals with significant long-term care needs from institutional to community settings. The five states that participated in this study—Florida, Louisiana, New Jersey, Ohio and Washington—each received federal grants for nursing home transition activities and had varied experiences.

This report draws on interviews with state Medicaid program officials for insight into the issues that arise in establishing programs to move individuals with significant long-term care needs from institutional to community settings. The five states that participated in this study—Florida, Louisiana, New Jersey, Ohio and Washington—each received federal grants for nursing home transition activities and had varied experiences.

Due to concern that wealthy elderly Americans were transferring assets to gain Medicaid coverage for nursing home care, the Deficit Reduction Act tightened Medicaid eligibility rules. About 43 percent of all nursing home residents eventually become Medicaid eligible. Over the six-year period examined, the authors estimate that, when applying the DRA asset transfer rules, federal savings to Medicaid could amount to $1.87 billion.

This summary of the Home and Community Based Services (HCBS) State Plan Amendment (SPA) option is based on a review of the Deficit Reduction Act (DRA) and discussion from the April 3, 2006 conference call with CMS staff and Real Choice grantees. The content reflects the Rutgers/NASHP TA collaborations understanding of the legislation and questions raised by grantees. The intent is to highlight what is known about the DRA and some questions about how it will affect States that elect this option.

What are the opportunities and potential pitfalls of this new policy that makes major changes to the Medicaid program? This paper offers explanation and analysis of the changes to the long-term services policies including: Asset Transfers, Long-term care Partnership Programs, Family Opportunity Act, Money Follows the Person Demonstration, State Option to Provide HCBS Services, Cash and Counseling Option.

On March 31, 2006, HHS Secretary Michael Leavitt outlined new flexibilities available to states under the Deficit Reduction Act (DRA) of 2005 (Pub.L. No. 109-171). Find out how the new DRA provisions may link with other options available under Medicaid to transform long-term care to person-centered care and to expand coverage for individuals with disabilities, increase access to community supports, and promote personal responsibility, independence, and choice.