New York

This paper discusses the progress states have made in moving away from institutional care for Long-Term Supports and Services and toward home and community-based programs. It analyzes the opportunities available through the Affordable Care Act and other programs whereby states can continue that progress even in a challenging budget environment.

This survey reports on trends in Medicaid spending, enrollment and policy initiatives for FY 2012 and FY 2013. The report describes policy changes in reimbursement, eligibility, benefits, delivery systems and long-term care, as well as detailed appendices with state-by-state information, and a more in-depth look through four state-specific case studies of the Medicaid budget and policy decisions in Massachusetts, Ohio, Oregon and Texas.

MFP demonstration supports states' efforts to help Medicaid beneficiaries living in long-term care institutions transition back to community-based residences and make LTSS more accessible. Using nursing home assessment data, this report compared needs of MFP participants with a cohort of Medicaid long-stay nursing home residents who transitioned to HCBS in grantee states but were not enrolled in MFP, and a cohort of long-stay residents in MFP states who did not transition.

This paper examines the contents of the 26 states’ proposals, which intent to test on two models related to financing dual eligible beneficiaries, in the areas of target population, implementation date, enrollment, financing, benefits, beneficiary protections, stakeholder engagement, and demonstration evaluation as set out in the states’ initial submission to CMS. Negotiations between CMS and the states are ongoing and are likely to result in some changes from the states’ initial proposals.

The affordability of private pay services is an important component of LTSS system performance. This Insight on the Issues presents data on private pay affordability for every state and more than 400 markets in the U.S. There is wide variation in affordability between states and markets. Private pay nursing home care is not affordable for middle-income families. While less costly than nursing homes, home health care is still unaffordable for middle-income older people at typical levels of use.

This web link is an online, searchable menu of policies and programs -each with a rating based on strength of evidence for factors that can help make communities healthier places to live, learn, work and play. Each of the policies, such as increased alcohol taxes, for example, and programs, such as early childhood interventions, included in What Works for Health is given evidence rating to help guide users toward choosing proven strategies.

The Workforce Investment Act (WIA) is the largest source of federally-funded employment and training services. WIA allows states to apply for waivers of WIA regulations to provide greater flexibility in serving the needs of local populations. The Department of Labor approved more than 750 state-requested waivers of statutory and regulatory requirements between 2008-2010. This report evaluates selected waivers during the time period to examine the possible effects of waiver implementation.

What actions states are taking to implement the Medicaid expansion? Specifically, the report addresses the following questions: (1) What are the states' responsibilities for implementing the Medicaid expansion? (2) What actions have selected states taken to prepare for the Medicaid expansion, and what challenges have they encountered?, and (3) What are states' views on the fiscal implications of the Medicaid expansion on state budget planning?

The Senate Finance Committee asked GAO to analyze states' requirements and practices for assessing the financial eligibility of applicants for Medicaid long-term care coverage. This report presents findings on the extent to which states (1) require documentation on assets from applicants, (2) obtain information from third parties to verify applicants' assets, and (3) obtain information about applicants' assets that could be used to implement eligibility-related DRA provisions.

Published for the past 18 years, the Across the States series was developed to help inform policy discussions among public and private sector leaders in long-term services and supports throughout the U.S. Across the States 2012 presents comparable state-level and national data for more than 140 indicators, drawn together from a wide variety of sources into a single reference. This publication presents up-to-date data and is displayed in easy-to-use maps, graphics, tables, and state profiles.