Real Choice Systems Change

Developing HCBS alternatives to institutional care has been a priority for many state Medicaid programs over the last three decades. While the majority of long-term care dollars still go toward institutional care, the national percentage of spending on HCBS has more than doubled from 19 percent in 1995 to 41 percent in 2007. This article presents a summary of the main trends to emerge from the latest (2006) expenditures and participant data for the three main Medicaid HCBS programs.

Developed by an FMS provider, this handout offers guidance to participants on becoming employers, through fiscal intermediary services, as determined in their Person Centered Plan.

CMS awarded the fourth round of 3-year grants for RCSC in Sept 2004. Three categories of grants were awarded: Research and Demonstration grants (40), Technical Assistance grants (10), and Feasibility Study and Development grants (2). This report focuses on the outcomes and Enduring Systems Improvements in Housing, Comprehensive Systems Reform, Mental Health Systems Transformation, Quality, Rebalancing, and Family to Family Grantees.

Here are resources used to educate consumers about MN’s Consumer Directed Community Supports, Personal Care Assistance, and Road to Independence programs. The first handbook gives guidance on the processes and protections of consumer direction and also provides sample care plans and assessments. The handbook on personal care assistance is available in English, Somali and Vietnamese and reviews eligibility, management, and use of services. The last guide assists in moving out of an institution.

Quality surveys were developed to be administered by consumers to other consumers and their families. They measure in-home attendant care, habilitation, and respite services delivered. In addition to surveys are materials used to train the interviewers, survey response thresholds, and a presentation outlining survey findings.

The three-year study examined relevant policy, program design, and cultural implications that may have an impact on enabling self-directed Medicaid beneficiaries to save money without losing benefits. Using extensive stakeholder engagement, six elements were studied: savings models; costs and benefits of self-direction; Federal tax policy; state policy context; participant needs; and an implementation plan.

Program administrators, advocates, and researchers advise the Senate on ways to improve wellbeing and cost outcomes of long-term care by increasing access to HCBS. They speak on national demographics, successful HCBS programs of the past and present, state programs in Wisconsin and Florida, integrating acute and long-term care for dual eligibles, and program finance models. See “Video Contents Index” for time stamps and information on each testimony.

This quality services review consists of direct feedback from individuals who receive services, record reviews, observations, and discussions with agency staff. Agencies are reviewed against clear benchmarks and receive feedback from review staff throughout the process. Quality Action Plans address areas for improvement and are completed by each agency with technical assistance provided by the Quality Management Unit.

This resource guide gives consumers information about quality in long term care services, outcomes expected from services, and information about how the state of Vermont assures and improves its services. It also discusses the how consumers can receive more information or assistance and their role in assuring and improving quality of services. Other states can use this as a template when designing their own quality programs.

How do you explain the long-term system and benefits available in your state to consumers? Use these resources from Arizona as examples of how to communicate to people with developmental disabilities their choices, rights, and responsibilities. Also covered are eligibility requirements, application instructions, and contact information of local offices.