1915c

This report presents the results of a survey of state developmental disabilities agency officials regarding the determination of initial eligibility/level of care and the “annual level of care” for services furnished under Medicaid waiver and ICF/MR programs. Forty-seven (92%) states provided information on state waiver eligibility criteria and practices. The report describes state level of care assessment approaches and provides legislative cites and contact information for state staff.

This issue brief and background paper outline the ongoing history, services, and expenditures associated with the Older Americans Act (OAA). The report also summarizes services that are funded through the OAA and other federal and state funds and are provided by the state and local agencies that comprise the Aging Services Network. Finally, key challenges to meeting the needs of the changing population are identified, especially with regards to service improvement and funding.

The authors examined whether consumer direction is effective for elderly people with mental illness. The treatment group, those that participated in Cash and Counseling, fared better than elderly people that have a mental illness but did not participate in C&C. They also fared as well as elderly people without mental illness that were in the program. Variables studied included measures of consumer satisfaction as well as objective measures such as health, among others.

The authors identified trends regarding the use of 1915(c) waivers to buy assistive technology (AT). They examined participation and expenditures as well as differences in provision between elderly people and individuals with developmental disabilities. Results showed that the use of waivers to fund AT is growing, but more slowly than the overall waiver program. Also, there are significant differences in provision between people with disabilities and older adults as well as between states.

Centers for Independent Living (CILs) have been providing important services to individuals with disabilities since the 1970s. State Medicaid programs have contracted with CILs to provide Medicaid-funded services. This paper examines four important home and community-based services (HCBS) provided by CILs and funded by Medicaid: case management/support coordination; personal assistance services; nursing facility transition services; and equipment and home modification.

State leaders are interested in the experience of states that developed adult foster care as part of their service array, trends in provider supply, regulations governing providers, and quality oversight practices. This report is based on the policies and practices in five states – Arizona, Maine, Oregon, Washington and Wisconsin. The states were selected based on their approach to licensing and Medicaid coverage for this residential option. The report focuses on programs for older adults.

In order for Oregon to balance its two-year budget for 2001-03, the Seniors and People with Disabilities Division (SPD) in the Department of Human Services was mandated to reduce LTC spending by nearly 30%. This paper analyzes the 2003 cuts to Oregon’s Medicaid long-term care (LTC) system, the impact of those cuts on a well-developed home and community-based services (HCBS) system, how the state has responded, and lessons that could be learned from its response.

In late 2007, the Center for State Health Policy surveyed 23 states that operate Medicaid waivers targeted to individuals with brain injuries. Data was obtained about the cost and number of individuals served by these waivers for the waiver years 2002 through 2006. Three states began waivers for those with brain injuries in 2002 or later, and 3 other states discontinued waivers in 2006. Every state except Arizona has multiple Medicaid 1915(c) home and community-based services (HCBS) waivers.

The purpose of this compendium is to establish baseline knowledge of the scope of assistive technology and home modification services that states make available to Medicaid-eligible adults. This study provides federal and state policymakers with basic information to inform planning and policy development. It also provides other stakeholders, including consumers, with valuable information about Medicaid State Plan and HCBS waiver.

Launched on November 17, 2006, this website assists states in applying for their waiver. The site offers training materials, a migration protocol, a copy of the application, and a technical guide. Many questions can be answered in the FAQ section. The application can be downloaded as an html file in order to save your work. States can also allow CMS to view a draft before submitting a final copy.