AARP Public Policy Institute

States now have more discretion in changing Medicaid policies; consumers and advocates want to make sure they have a voice in that. This AARP Public Policy Institute Issue Paper examines the processes states have in place to solicit public input into Medicaid policy changes developed and implemented through Section 1115 waivers or State Plan Amendments (SPAs). Recommendations are offered on how federal and state governments can improve or enhance existing opportunities for public involvement.

This AARP Public Policy Institute Issue Brief discusses the financial impact of caregiving on the caregivers themselves as well as the economic value of their contributions to society. It compares the economic value of family caregiving to other benchmarks in order to underscore the magnitude of these unpaid contributions, presents estimates of productivity losses to U.S. businesses, and highlights the critical role that family caregivers play in the nation's long-term care system.

The US is experiencing a severe shortage of qualified direct-care workers to provide personal care services (PCS). Evidence from a number of studies reveals that wages and benefits paid to PCS workers play a fundamental role in determining the quality and quantity of workers. Read this in-depth analysis of state and local practices that reviews the pros and cons of seven strategies for enhancing PCS-worker wages and benefits for direct-care workers delivering Medicaid personal care services.

States vary greatly in the proportion of Medicaid long-term care funds expended on home and community-based services. In 2005, Oregon and New Mexico spent over two-thirds of their Medicaid LTC dollars on HCBS while Washington, D.C. and Mississippi spent less than 20 percent on HCBS. To overcome the “imbalance” states, at varying rates, have been “rebalancing” the way that Medicaid LTC services are delivered and financed to allocate a higher proportion of dollars to HCBS.

A new survey shows overwhelming support for giving residents choices for long-term care in the home and community. Tennessee is last in the nation in providing options in long-term care. AARP commissioned this survey to determine where voters stand on key issues. Voters say they are more likely to vote for state candidates who support allowing funds now used only for nursing homes to also be available for alternative services which help older and disabled Tennesseans remain independent.

AARP has developed a two page fact sheet that outlines the definitions, need, funding and expansion options for home and community based services.

In the past decade consumer-directed (CD) services have proliferated in public programs. AARP has developed a two page Fact Sheet that offers an short overview of consumer preferences, program characteristics, the role of fiscal agents, and the ways consumer direction is expanding.

This AARP Public Policy Institute Issue Paper examines the efforts of South Carolina, Washington and Wisconsin to improve home care quality by using a more person-centered approach. The initiatives described in this report point to the significant ongoing efforts that states are using to ensure quality care and support in the home. The challenge for state officials continues to be the creation of quality assurance systems that place consumer needs and goals for quality of life first.

Can agency consolidation bring about consistent policymaking and focus long term care services on persons with disabilities rather than on program providers? This AARP Public Policy Institute Issue Paper provides readers with an examination of a consolidated agency approach, by studying agency structure, reviewing the arguments for consolidation, and the barriers to achieving it. It also reviews several states accomplishing consolidation and a checklist of steps towards such a model.

Informal caregiving has long been the most common source of long-term care for older persons with disability however; a number of factors such as demographic trends may reduce the supply of traditional family caregivers and changes in the LTC delivery system indicate the need to track the changes. This paper examines key trends in family caregiving patterns. The findings should help to inform public policy debates and the data provides evidence of the need to provide adequate long-term services.