Olmstead

This memorandum presents data on Medicaid long-term care expenditures in Federal Fiscal Year 2007 (Oct 2006-Sept 2007). Table 1 presents national data on Medicaid expenditures for Long-Term Care from 1995-2007. Other tables present state-by-state data for Nursing Homes, ICF/MR, Personal Care, HCBS Waivers, Home Health, Home Care, 1115 Waivers focused on HCBS, and other Medicaid services.

Attached is an initial guide for use by States regarding current CMS case-management policy in light of the moratorium. This document does not represent a comprehensive list of all relevant Medicaid policy issuances, but is designed to assist States in assessing the impact of the exception included in the CMS 2237-IFC moratorium. The Supplemental Appropriations Act, 2008, was signed into law on June 30, 2008. State Medicaid Director (SMD) Letters are included as reference.

This report examines common barriers that mental health consumers face in accessing transportation and provides emerging best practices for overcoming these barriers. Successful strategies include expanding access to existing public transit as well as providing specialized transportation. They encompass urban, suburban, and rural settings. The report also lists potential funding sources and recommendations for developing transportation initiatives.

This paper models the effect of occupancy rates on nursing home reimbursement. It surveys nursing home methodologies generally and specifically models the rate setting systems of California, Indiana and Pennsylvania. The modeling indicates that much of “the fixed costs” would not get calculated back into the rates. The costs that do would be allocated across all resident days used in rate setting regardless of payer source, including Medicare and private pay, limiting the Medicaid impact.

CMS has proposed rule changes to implement Section 1915(i) of the Social Security Act. 1915(i) enables states to provide a prescribed set of HCBS to individuals that earn less than 150% of the Federal Poverty Level and require less than institutional levels of care. It does so without requiring waivers (as in 1915(c)), consumer eligibility for institutional care, or a cost savings demonstration. Further background information and instructions for comment submission are included.

For states that receive federal funding, the Olmstead decision confirmed the obligation to serve individuals with disabilities in more integrated settings rather than provide supports and services in institutional settings. As states move forward with strategies to support community living for individuals with disabilities and promote the principles of person-centered planning, these tools and strategies provide complimentary opportunities to accelerate the achievement of inclusive outcomes.

In February 2006, a Round Table Discussion Meeting was held in Oregon to identify and analyze policies and strategies that maintain or increase the availability of supported employment services to persons with developmental disabilities. The meeting focused on how such services may be preserved and expanded in Oregon, but in addition, national perspectives on supported employment were discussed. The discussion report, evaluation and graphic facilitation of the Round Table are included.

As part of the Oklahoma Real Choice Systems Change Grant, Oklahoma developed a number of training tools for their partnership members. The group consisted of Consumer Consultants and Grant Partners. The presentations and handouts describe roles, working as a team, communication, decision making, policy history, state specific divisions and services and the ADvantage program.

This memorandum presents data on Medicaid long-term care expenditures in Federal Fiscal Year 2006 (Oct 2005-Sept 2006). Table 1 presents national data on Medicaid expenditures for Long-Term Care from 1994-2006. Other tables present state-by-state data for Nursing Homes, ICF/MR, Personal Care, HCBS Waivers, Home Health, Home Care, Inpatient Hospital Care, Inpatient DSH, Inpatient Mental Health, Mental Health DSH, Medicaid Managed-Care, Prescribed Drugs, Targeted Case Management and PACE.

The New Jersey Department of Human Services’ Division of Developmental Disabilities (DDD) presents their action plan for systems change. This Plan outlines the process of transitioning individuals with developmental disabilities from developmental centers (DCs) to the community over the next 8 years (State FY 2008 through FY 2015). The Plan addresses the requirements of state legislation (S1090, PL 2006, Chapter 61) as well as the issues in the NJ P&A Olmstead lawsuit.