All States/Territories

This letter informs States of several changes to Section 1915(i) of the Social Security Act (the Act) made by the Affordable Care Act (ACA). These changes, which become effective October 1, 2010, include revised and new 1915(i) provisions for removal of barriers to offering HCBS services through the Medicaid State plan. This letter is intended to provide guidance on important changes to the law including: Number Served & Statewideness, Financial Eligibility, Targeted Benefits and Services.

This letter provides guidance to State Medicaid agencies regarding implementation of section 4201 of the American Recovery and Reinvestment Act of 2009 (the Recovery Act), Pub. L. 111-5, and our recently published regulations at 42 CFR Part 495, Subpart D. Section 4201, as well as our final regulations, will allow the payment of incentives to eligible professionals (EPs) and eligible hospitals to promote the adoption and meaningful use of certified electronic health record (EHR) technology.

Experts were asked about the current state of LTC in the US and potential reforms in the delivery and financing of these services. Eight articles appearing in the August 2010 issue of Medical Care Research and Review explore the survey findings and analysis, revealing opinions on the state of the industry, the nature of its problems, its dissatisfaction with past efforts at repair, and its preferences for future strategies for improvement.

Find interactive timelines for health insurance, revenue and delivery system reform provisions of the Affordable Care Act. An graphic overview is included, as well as PDF documents with interactive year by year listings of the legislation’s provisions.

What are the key health reform provisions related to investments in direct-care worker training and workforce development? This fact sheet highlights national advisory panels as well as grant opportunities for states and individual employers. Action steps and additional resources are included.

Innovative applications of technology in Medicaid are highlighted in this series of profiles from varying states. Louisiana, a pioneer in using “Express Lane Eligibility” (ELE) is examined in this report. ELE allows Medicaid and CHIP agencies to use eligibility findings from other public programs to identify, enroll, and recertify participants. Despite a 12% reduction in the Medicaid workforce over the last two years, the volume and quality of service has remained consistent.

First in a series, this brief presents findings from AoA’s National Survey of Older Americans Act Program Participants. Findings indicated that Title III participants were at a higher risk of entering a nursing home compared to others in their age group. The authors conclude that AoA, however, is effectively reaching those most at risk of institutionalization, and that Title III services play an important role in helping elderly adults remain living independently in the community.

Read the evaluation report of a training project for case management agencies that coordinate home care and Medicaid waiver services for older residents (Aging Services Access Points). The curriculum encouraged a shift in philosophy and explained the roles of consumers and case managers guided by a consumer-directed philosophy. Results indicated that the regional training was highly effective in achieving its goals. Detailed information about methods of training and evaluation are included.

Ten grants were awarded to states to develop a profile of the publicly funded LTC system and to assist CMS to develop national benchmarks that will be used to measure the degree and success of states' efforts to offer community based LTC services. Review Michigan’s report which focuses on the priority population of the elderly and adults with physical disabilities, but also includes systems that serve adults with developmental disabilities, adults with mental illness and children.

Find case studies and articles related to organizational change from traditional facility and group-based services to individualized supports. Reports present learned lessons and challenges based on site visits to organizations which offer supports for community living, employment and are engaged in change initiatives. New reports from 2011 include "Organizational Change: Approaches & Strategies" and "Stepping out of the Organizational Comfort Zone."