All States/Territories

Find state-developed resources on a variety of health reform implementation topics. The site is designed to support state officials working to implement health reform. States are encouraged to share their own resources as well as learn from others. Resources include state-specific overview analyses, work plans, timelines, progress reports, fiscal analyses, proposals for federal funding, state implementation websites and more.

Presentations from NASHP's 23rd annual conference held October 4-6 in New Orleans are available online. Included are remarks from CMS Administrator Donald Berwick , and presentations such as Health Care Reform: New Options for Rebalancing Long Term Services and Supports, Integrating Care for Dual Eligibles, Reforming State Long Term Services and Supports Programs through Participant Direction, and numerous others. Review the presentations about vital issues in state health policy.

Fiscal year 2010 presented the most difficult challenge for states' financial management since the Great Depression, according to this biannual state fiscal report. With a big drop in revenues from income taxes and other sources, the states are facing their worst fiscal squeeze in decades, as they try to keep programs running for more people, but have fewer dollars to spend. Budget cuts threaten health and social service programs, including the delivery of long-term services and supports.

This letter provides initial guidance on section 6411 of the Affordable Care Act, Expansion of the Recovery Audit Contractor (RAC) Program, which amends section 1902(a)(42) of the SSA requiring States to establish programs to contract with RACs to audit payments to Medicaid providers by December 31, 2010. CMS expects States to fully implement their RAC programs by April 1, 2011. As required by statute, CMS will be issuing regulations in this area shortly, providing additional guidance.

Several programs based on promising models for improving care for people with chronic conditions, who often experience difficult transitions across care settings that can compromise quality of care and increase costs were created by the heath care reform law. Most of these programs include some level of funding, evaluation, and discretion for the HHS Secretary to expand programs if they meet certain criteria. This fact sheet delineates these programs.

How does ACA provide new financial incentives for states, and create opportunities within existing programs to promote Medicaid HCBS for older persons and adults with disabilities? The number and variety of new options, combined with the prospect of additional federal funds, may give some states added flexibility in balancing their LTC system. Read this fact sheet which enumerates the new programs and modifications to existing ones.

Medicaid finances nearly half of all LTSS spending. Review an update to existing data on Medicaid financial eligibility standards for nursing home and HCBS waiver services for older persons and adults with disability. 2009 data were obtained on state selection of optional pathways for eligibility, income and asset standards, cost-sharing and other post-eligibility financial requirements. A copy of the survey instrument and accompanying letter to state Medicaid Directors are included.

Disability rates among older Americans have declined, and the ways in which community-dwelling older people with disabilities managed their conditions have substantially changed over the 20 years covered by this survey. Among those receiving human assistance, the vast majority were helped by family caregivers, who are increasingly taking full responsibility for providing care. Find detailed analyses of the data in two research reports that provide insight into the factors driving these changes.

State-authorized health plans whose members are qualified to receive both Medicare and Medicaid benefits face administrative challenges. This study examines care management practices in four health plans that serve persons who are dually eligible. The authors describe how health plans operationalize their integrated care management approaches and identify a common framework for integrating care.

States are curtailing optional services, extending waiting lists, cutting provider reimbursement, and taking other measures to cope with the worst economic downturn in 70 years according to a comprehensive 50 state survey. Even as state revenues shrink, the demand for services is increasing. On a brighter note, many states may participate in expanded HCBS services through ACA opportunities. Review preliminary findings presented at the National HCBS Conference in September, 2010.