Maryland

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.

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.

This updated resource, the first reflecting a ten year perspective, provides a state-by-state look at wages and wage trends for PHCAs, the fourth fastest growing occupation in the country, and a key job title within the direct care workforce. Prepared as a resource guide on wages for advocates and policymakers concerned with this workforce, the data underscore the problem of low wages for PHCAs, factors contributing to workforce instability and near poverty incomes for this workforce.

This report is the latest in a series of annual reports that present expenditures data for Medicaid Home and Community-Based Services (HCBS) waivers authorized under Section 1915(c) of the Social Security Act. Table 1 presents reported Federal Fiscal Year (FY) 2009 expenditures for each HCBS waiver in effect during that year. Table 2 presents HCBS waiver expenditures data from FY 2004 through FY 2009 by state. The remaining tables present data according to the populations served in waivers.

This report is the latest in a series of annual reports on Medicaid long-term care expenditures. Table 1 presents national expenditures data for FY 1997–FY 2009. Tables A through T present state-by-state expenditures data for FY 2004–FY 2009 for specific categories of service. Tables U, V, and W present the distribution of each state’s LTC expenditures among institutional and community-based services.

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."

Are MIGs assisting individuals with disabilities to become employed? An annual GPRA report has been produced since 2007. This report builds on previous work, and shows the continued impact of MIG funding in 2008 on programs and services that facilitate employment among individuals with disabilities. As the MIG program approaches the end of its authorized period, many states are committing to evaluating the programs, documenting their impacts, and sustaining the efforts beyond 2011.

Integral to the coverage framework laid out in the reform law is a dramatic expansion of the Medicaid program. This primer provides key information about the program today, including a definition of what it is, who and what services are covered, Medicaid expenditures and how they are financed, and information of how health reform reshapes the program for the future.

Find a synopsis of how state coordinating councils operate, including a 50-state reference table, and profiles of the 25 existing state coordinating councils. Focused on improving coordination at the state and local levels, the Councils are a key to successfully keeping people in the community. Some of these states have created their Councils by state statute, some by state executive order or governor initiative.

Explore Medicaid expansion under health care reform and savings for states through Medicaid “modernization.” This report examines three broad categories of savings opportunities including the greater use of coordinated care techniques, the greater use of managed care for LTC, and the upgrading of Medicaid’s administrative processes. Find national and state-specific projections of increases in Medicaid enrollees as a result of health reform legislation and of the associated Medicaid costs.