Kaiser Family Foundation

This primer describes long-term services and supports (LTSS) delivery and financing in the U.S. and highlights covered services and supports, types of care providers and care settings, beneficiary subpopulations, costs and financing models, quality improvement efforts, and recent LTSS reform initiatives.

This report reflects on Medicaid’s accomplishments and challenges and considers the issues on the horizon that will influence the course of this major health coverage and financing program moving forward. The report follows Medicaid’s evolution, including major legislative changes and other inflection points in the program’s history and analyzes how Medicaid threads through our health care system today and the measure of its impact.

This report shares findings from an investigation with 400 people with disabilities who have experienced poverty. Their experiences identified six major factors that limit the ability of people with disabilities to gain employment and contribute to a disproportionate number living in poverty.

In this report, the GAO examined claims, expenditure, and quality data from Dual Eligible Special Needs Plans (D-SNPs) during 2009. The GAO notes that D-SNPs with higher levels of Medicare and Medicaid integration performed better on quality outcomes but did not reduce utilization of costly Medicare services. The GAO concludes that CMS projected savings from the Financial Alignment Demonstration and other initiatives to integrate care for dual eligible beneficiaries may be overstated.

The OIG report examines state standards and requirements for network adequacy and access to care. The report was based on surveys and interviews of state officials, CMS employees, and External Quality Review Organizations. In the report, OIG notes that state standards on access to care vary widely, and that state oversight of health plans also varies. Based on its findings, OIG offers recommendations to CMS in the report.

Access to affordable health insurance is essential to the ability of people with disabilities to seek and maintain employment. As their income fluctuates, people may migrate between Medicaid and Marketplace coverage, and they may face changes in their benefits and out-of-pocket responsibilities as a consequence. This issue brief uses hypothetical examples of working people with disabilities to illustrate the experiences they might have with Medicaid and Marketplace coverage in four states.

Medicaid LTSS is not a system that was purposefully built, but rather one that evolved over time out of legacy programs that were designed to meet the needs of different populations, differing state approaches to policy, court decisions, client advocacy, and changing ideas about where and how LTSS should be provided. MACPAC’s future work on Medicaid LTSS will focus on building a better understanding and moving policy in the direction of a more efficient and effective system of LTSS.

This tool promotes consumer-focused MLTSS by making it easier to identify weaknesses and promote better practices. The tool combines a checklist for assessing MLTSS with examples of practices, policies or contract language that implement the criteria.

This toolkit helps health plans and provider groups effectively engage, learn from and strategize with their diverse members and communities about the best ways to deliver person-centered care and support.

This report summarizes audited Healthcare Effectiveness Data and Information Set (HEDIS) results for calendar year 2013. Data come from a record number of health plans -- 814 HMOs and 353 PPOs, representing more than 171 million people, or 54 percent of the U.S. population.