Deficit Reduction Act (DRA)

This table is modified from previous chart received during CMS Presentation at 2003 HCBS Waiver Conference (October 28, 2003 Milwaukee, WI) and in draft form. It compares the 1915c, 1115, or DRA for the following issues: Level of Care/ Eligibility, Combining Populations, Budget Neutrality, Reporting, Renewal, and Evaluation, Support Brokerage, Cash Allowance, Hiring Legally Responsible Individuals, Provider Agreements, Direct Payment to Providers, Payment for Services.

The Census Bureau created the supplemental poverty measure, in an effort to differently reflect cost of living and financial status from the "official" measure. Poverty rates among older adults are higher under the supplemental poverty measure (15%) than under the official poverty measure (9%). This analysis does a state-by-state comparison using both poverty measures to describe seniors living in poverty. An understanding of elder financial hardship is important for fiscal policy debate.

CMS has released two important documents that outline essential elements of MLTSS programs that are in line with current best practices. The first document summarizes these essential elements and the second provides guidance for incorporating these essential elements into MLTSS programs operating under section 1115 or 1915(b) authorities. These standards will be used when CMS reviews states’ design, implementation and operation of MLTSS programs for approval and ongoing quality assurance.

Money Follows the Person (MFP) federal grants are provided to states in order to assist older adults and people with disabilities in transitioning from nursing facilities to home and community based settings. A history and current state of MFP are offered. This report provides an overview of how MFP has helped states to rebalance their LTSS programs and provides next steps and an outlook for the future of MFP or similar programs once the demonstration project’s funding has run out.

An updated fiscal outlook of state and local governments projects an ever increasing gap between receipts and expenditures through 2060, absent any policy changes. The report found that this decline in the state and local government sectors' operating balance is primarily due to rising health related costs of state and local expenditures on Medicaid and the cost of health care compensation for state and local government employees and retirees.

This guide lays out information about each federal program that provides or could provide respite funding or support. It is meant to be used by state Lifespan Respite Care Programs & their partners to help identify the funding sources that could be the building blocks for the state’s Lifespan Respite systems, help serve the underserved, build respite capacity & quality and help recruit & retain respite workers, and identify individuals who administer funds for future partnerships.

States have faced considerable challenges, but by the end of 2009, MFP programs had helped approximately 5,600 people transition to community living. This report describes the program’s status through December 2009, including how states are progressing toward their goals, and provides baseline information for analyses of impacts and outcomes.

Findings in this report focus on what has been learned about the status of grant implementation and factors that facilitate progress early and throughout the implementation period, and progress on grantees’ goals and achievement of Systems Transformation (ST). It presents results for both FY05 and FY06 ST Grantees, builds on findings from the first annual report and focuses on two different stages of implementation for the FY05 grantees (Year 3) and the FY06 grantees(initial 15-months).