New Jersey

This GAO report examines (1) the extent to which Medicaid enrollees have private insurance, and (2) the state and CMS initiatives to improve third-party liability (TPL). Given the findings in the report, GAO recommends that CMS routinely monitor and share information regarding key TPL efforts and challenges, as well as provide guidance on state oversight of TPL efforts conducted by Medicaid managed care plans.

The Affordable Care Act (ACA) provides new but limited opportunities to promote or fund specialized transportation services for older people and adults with disabilities. This paper explains how states can use these largely untapped options to expand services for targeted low-income populations with mobility needs. It also presents two case studies illustrating how the Atlanta region and the state of Connecticut are making this work.

As almost half of the States have implemented MLTSS programs, community-based organizations, will be significantly impacted. At the 2013 HCBS conference, ADvancing States, with support from the SCAN Foundation, held a day-long intensive to discuss these impacts. This report outlines 5 discrete roles that CBOs are well-suited to play in MLTSS programs using as a reference point CMS’ 2013 guidance on MLTSS program design and implementation. To request a hard copy version, email Ali Diaz at adiaz@advancingstates.org.

This study focuses on understanding the rates and patterns of enrollment in Medicaid among individuals already enrolled in Medicare, the factors that predict this transition to dual coverage, and those that predict nursing home entry. This volume of this report is a descriptive examination of the number and characteristics of Medicare beneficiaries who transition to dual coverage in the coming year.

This study aimed to describe and characterize the published literature on disparities between racial and ethnic groups among individuals with Alzheimer's disease and related dementias. The literature shows consistent and adverse disparities among blacks and Hispanics compared to non-Hispanic whites in the prevalence and incidence of Alzheimer's disease, mortality, participation in clinical trials, use of medications, use of LTSS, health care expenditures, quality of care, and caregiving.

The Non-Elderly Disabled Category 2 (NED2) Housing Choice Voucher Program aimed to increase access to affordable housing for non-elderly people (age 62 and under) with disabilities currently residing in institutions, such as a nursing home. This evaluation examined the program's implementation in a subset of communities that received NED2 vouchers and estimated the impact of the program on the change in the rate of community transitions among the eligible population.

Despite states' rebalance of long-term care (LTC) systems with greater emphasis on home and community-based services (HCBS), many low-income elderly, persons with physical disabilities, and persons with intellectual/developmental disabilities continue to reside in institutions. Through an analysis of Medicaid enrollment and LTC claims data, this report provides information on the characteristics of institutionalized enrollees, their stays, and the interaction of institutional services and HCBS.

This report is a comprehensive account of the number of individuals in each state who received Medicaid-funded LTSS in calendar year 2010 based on the Medicaid Analytic eXtract (MAX). The MAX data source is a set of Medicaid administrative data files designed to facilitate Medicaid research. The report identifies the number of people by population group who received institutional and non-institutional services. With some exceptions, State and national data are included.

In this report, the GAO examined claims, expenditure, and quality data from Dual Eligible Special Needs Plans (D-SNPs) during 2009. The GAO notes that D-SNPs with higher levels of Medicare and Medicaid integration performed better on quality outcomes but did not reduce utilization of costly Medicare services. The GAO concludes that CMS projected savings from the Financial Alignment Demonstration and other initiatives to integrate care for dual eligible beneficiaries may be overstated.

The OIG report examines state standards and requirements for network adequacy and access to care. The report was based on surveys and interviews of state officials, CMS employees, and External Quality Review Organizations. In the report, OIG notes that state standards on access to care vary widely, and that state oversight of health plans also varies. Based on its findings, OIG offers recommendations to CMS in the report.