Deficit Reduction Act (DRA)

Over the last eight years, federal, state, and local governments have re-envisioned how to deliver and pay for an ever-growing caseload of elderly individuals and persons with disabilities who need services at home, in the workplace, or in more costly nursing facilities. This discussion provides a vision and a context for HCBS reform consistent with CMS’ vision for reforming post-acute care that focuses on addressing system barriers and informing and empowering health care consumers.

The Compendium contains basic information about each of the Real Choice Systems Change Grantees receiving awards in FY 2004. It includes information for the Family-to-Family and Systems Transformation Grantees who received awards in FY 2005 and FY 2006 plus the Person-Centered Planning Implementation awards in FY 2007. It is divided into sections corresponding to the different types of grants and year of award; the report helps Grantees identify others with similar goals and activities.

The national percentage of Medicaid spending on home and community-based services (HCBS) has more than doubled from 1992 to 2004. This report presents a summary of the main trends to emerge for the three Medicaid HCBS programs and the results of a survey of policies such as eligibility criteria and waiting lists.

The purpose of this survey analysis is to provide states with an overview of the implementation of these DRA changes across the country, specifically in terms of Long-Term Care services and the steps the states have taken. Findings address eligibility, Children with Disabilities, Money Follows the Person, HCBS State Plan Amendments, Transition from Institutions, Managed Care, SPA for Personal Care Services, Cash & Counseling, Care Coordination, Disease Management and Long-Term Care Reform.

According to a report by the Kaiser Foundation, Medicaid has become the major payer for long-term services and supports to low-income individuals, and a safety-net for those who become impoverished as a result of long-term care needs. In addition to concerns about the high costs of long-term care, recent developments have drawn attention to challenges facing Medicaid as a provider of long-term care. This paper describes these challenges and other issues facing the Medicaid program going forward.

This report from the Illinois RCSC Rebalancing Grant, quantifies the actual expenses faced by older residents living in the community and applies it to those living in a nursing home seeking reintegration to community living. Furthermore, it hopes to identify a floor of income required to sustain community residency. The analysis should be helpful in formulating system changes for programs including eligibility standards and policies.

The annual 50-state survey of state officials on Medicaid and state budget actions reports enrollment in Medicaid declined. This decline was driven primarily by two factors. States reported new citizenship documentation requirements were causing delays in processing applications, affecting individuals already eligible for the program. State officials also cited good economy and lower unemployment for reducing enrollment. 42 states expect to expand coverage to the uninsured in the next year.

This letter is one of a series providing guidance on the implementation of section 6087 of the Deficit Reduction Act of 2005, Public Law Number 109-171. Effective 1/1/07, Section 6087, (Cash & Counseling), adds subsection 1915(j) to the Social Security Act. States have the option to provide self-directed PAS to beneficiaries, without regard to the Medicaid requirements of comparability or statewideness. A State plan amendment (SPA) pre-print is enclosed to assist you in submitting an amendment.

The Deficit Reduction Act of 2005 adds a new section 1937 to the Social Security Act (the Act). Under section 1937 a state may amend its State plan to provide alternative benefit packages to some of its recipients without regard to comparability, statewideness, freedom of choice, or certain other traditional Medicaid requirements. This paper looks briefly at how Section 1937 might be used by a state to develop a LIFE Account model.

The 7th CMS New Freedom Initiative Conference was held March 5-7 in Baltimore. Presentations are available in both PDF and text formats. “Choice and Independence” is a key pillar of CMS’ vision for a person-centered long term services and supports system for the future. The 2007 conference focused on the policies, programs, and tools -including opportunities authorized by the Deficit Reduction Act– available to shape and carry out the vision.