Affordable Care Act (ACA)

This report, which was presented at the Long-Term Care Interest Group Colloquium at the June 2011 AcademyHealth Annual Research Meeting in Seattle, Washington, discusses progress in rebalancing Medicaid long-term services and supports (LTSS) spending, how the Affordable Care Act can support states’ continued efforts to rebalance LTSS, and opportunities for future research to support continued system transformation.

Most Medicaid beneficiaries are enrolled in some form of managed care. States are expected to increase their reliance on managed care to deliver services in their Medicaid programs. This 50-state survey provides a comprehensive look at state Medicaid managed care programs, documenting their diversity, examining how states monitor access and quality, and exploring emerging efforts to improve care, including managed long-term care and initiatives targeted toward dual eligibles.

Certain states significantly outperform others in the delivery of long-term services and supports (LTSS) to older adults and people with disabilities. The report examines four key dimensions of state LTSS system performance: affordability and access; choice of setting and provider; quality of life and quality of care; support for family caregivers. It assesses each state's performance overall as well as on 25 indicators, some of which measured for the first time. Compare data on the website.

This letter provides guidance to States on the implementation of Section 10202 of the Affordable Care Act, which establishes the “State Balancing Incentive Payments Program” hereafter referred to as the Balancing Incentive Program. This letter provides a high-level overview along with the required structural changes and timeframes for implementation. Also review the attached Section 10202 Initial Announcement.

The Affordable Care Act of 2010 offers a number of options and financial incentives for states seeking to expand their systems of long-term services and supports. Many of these opportunities can be leveraged to work together and to build on existing initiatives. Key provisions of the ACA are summarized, followed by considerations for states seeking to take advantage of these new opportunities.

The latest brief describes Medicaid expenditures in 2009, showing that 45% of its total long-term care dollars nationally were spent on home- and community-based services. The findings in this analysis are based on the CMS Form 64 data published by Thomson Reuters, detailing each state’s Medicaid expenditures.

The latest in a series provides background on the landscape of home- and community-based long-term care services funded by Medi-Cal, California's Medicaid program. In-Home Supportive Services (IHSS) is the largest personal care program in the nation.

This letter provides guidance on state flexibility to make changes to their home and community-based services (HCBS) programs while complying with the maintenance of effort (MOE) provision of the Affordable Care Act. Letter recommends that States contact CMS for technical assistance if they are interested in pursuing any changes to their long-term care policies. The accompanying Q&As provide guidance on the MOE provisions in the Patient Protection and Affordable Care Act.

Person-centered outcomes underpin all aspects of desired assisted living practices and care. Service planning and operational process focused on person-centeredness is able to deliver core promises of assisted living that maximize privacy, autonomy, and choice; fostering meaningful life, engagement, quality of care, and meaningful access to the surrounding community.

This policy brief examines the program created to provide financial support for home care, adult day care or a nursing home stay, and highlights how policy-makers could make the program sustainable. Options range from changing the premium structure and lengthening the vesting period, to incentivizing employers and more. The Obama administration acknowledges the program’s shortcomings and will ensure the program remains solvent and self-financing for at least 75 years, as the law requires.