Rutgers/NASHP

Centers for Independent Living (CILs) have been providing important services to individuals with disabilities since the 1970s. State Medicaid programs have contracted with CILs to provide Medicaid-funded services. This paper examines four important home and community-based services (HCBS) provided by CILs and funded by Medicaid: case management/support coordination; personal assistance services; nursing facility transition services; and equipment and home modification.

State leaders are interested in the experience of states that developed adult foster care as part of their service array, trends in provider supply, regulations governing providers, and quality oversight practices. This report is based on the policies and practices in five states – Arizona, Maine, Oregon, Washington and Wisconsin. The states were selected based on their approach to licensing and Medicaid coverage for this residential option. The report focuses on programs for older adults.

In order for Oregon to balance its two-year budget for 2001-03, the Seniors and People with Disabilities Division (SPD) in the Department of Human Services was mandated to reduce LTC spending by nearly 30%. This paper analyzes the 2003 cuts to Oregon’s Medicaid long-term care (LTC) system, the impact of those cuts on a well-developed home and community-based services (HCBS) system, how the state has responded, and lessons that could be learned from its response.

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The prevalence of the practice of transferring patients to sub-acute levels of care has created concerns with hospital discharge planners. Their apprehension arises from the possibility that if they do not quickly transfer patients from an acute care setting to a post-acute level of care, their hospital may be at an economic disadvantage to others with shorter lengths of stay due to differing transfer practices. This paper looks at four factors that mitigate the incentives to transfer patients.

This is a compendium of three discussion papers on the topics of direct service workers in long-term care and strategies for improving the quality of their jobs and services. The authors, each with a background that includes consultation and technical assistance on the topics, share the premises that these workers are fundamental to the future and quality of long-term care and that current and projected workforce shortages need to be addressed.

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 late 2007, the Center for State Health Policy surveyed 23 states that operate Medicaid waivers targeted to individuals with brain injuries. Data was obtained about the cost and number of individuals served by these waivers for the waiver years 2002 through 2006. Three states began waivers for those with brain injuries in 2002 or later, and 3 other states discontinued waivers in 2006. Every state except Arizona has multiple Medicaid 1915(c) home and community-based services (HCBS) waivers.

This study is intended to describe the nursing facility level of care determination processes in use by the states and to draw general conclusions from the data collected. When read in conjunction with the previous work in this area, this study will aid state staffs, CMS, and other parties interested in understanding how to improve post acute care assessment. The Appendix provide a brief description of data the state collects, the name of the assessment form, plus contact information.

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.