All States/Territories

This report focuses on creating a more balanced delivery system by expanding home and community-based services and reducing reliance on institutional care where possible is a major goal for virtually all states and the Centers for Medicare & Medicaid Services. The paper concludes by summarizing initiatives and drawing implications for the future financing of home and community-based services.

The proportion of long-term care spending that goes to institutional care has been dropping over time, from 81 percent in 1995 to 63 percent in 2005. However, there remains significant concern that many people who would prefer to receive care in the community are unable to do so because of what has been termed the ‘institutional bias’ of Medicaid. This report discusses the issues surrounding efforts underway to shift the balance toward HCBS in the state of Pennsylvania.

Looking for a way to gauge consumer satisfaction in self-direction programs? The state of Virginia Department of Medical Assistance Services (DMAS) conducts an annual Consumer-Directed Recipient Satisfaction Survey, to monitor the performance of the fiscal agent and to provide DMAS with feedback to assist in the development and implementation of quality improvement strategies. The first and second year statewide survey and findings from 2007 and 2008, are available below.

Looking for profiles of each State’s Home-and Community-Based Service (HCBS) programs? This project report covers the components of HCBS programs under multiple funding streams. It includes an overview of findings from cross-state comparisons with accompanying tables and charts and individual profiles of 48 states and Washington, DC. The findings are intended to provide states with information that can help guide their efforts to expand and improve HCBS programs.

This is the third report in a series, from Mathematica's five-year evaluation of the Money Follows Person demonstration, aimed at helping Medicaid enrollees transition, from long-term care institutions to the community. It describes states’ early implementation experiences and state transition activity as of December 2008. Also discussed, are the challenges that states have encountered in trying to launch the program, and implications for making fundamental changes in the long-term care system.

Developing HCBS alternatives to institutional care has been a priority for many state Medicaid programs over the last three decades. While the majority of long-term care dollars still go toward institutional care, the national percentage of spending on HCBS has more than doubled from 19 percent in 1995 to 41 percent in 2007. This article presents a summary of the main trends to emerge from the latest (2006) expenditures and participant data for the three main Medicaid HCBS programs.

FCA launched this online community promoting professional knowledge around families in their caregiving role. The site offers resources to help policymakers, professionals and family caregivers develop caregiver-friendly legislation or initiatives, implement caregiver support programs or services, and access information to enhance the delivery of quality care. Interactive site features include an online forum and user submissions.

Review the findings from a survey of eldercare and disability services employers. While most employers in the state offered employer-sponsored insurance, less than one-fifth of Massachusetts direct-care workers were enrolled in 2009. Based primarily on data from the survey, the main reason for the low number and recommendations are outlined in this report that deals with the impact of Massachusetts health reform on the eldercare and disability services sector.

What is the cost of providing job accommodation? Recent amendments to the Americans with Disabilities Act (ADA) refocused attention on workplace accommodations by broadening the definition of disability. This increased attention has some employers concerned about the costs of providing job accommodations. However, a study conducted by the Job Accommodation Network (JAN), shows that workplace accommodations not only are low cost, but also positively impact the workplace in many ways.

Making use of data and knowledge sharing to drive benefits outreach, enrollment, and retention efforts promotes the efficient use of limited resources, states a new issue brief from NCOA's National Center for Benefits Outreach & Enrollment. Sharing data also can help enroll eligible individuals in more than one benefits program at a time.