South Carolina

Health plans for people with pre-existing mental illness, if they included mental health benefits at all, have historically been more expensive, with limited benefits and significant administrative hurdles to obtaining care.This report describes a survey conducted by NAMI to assess the experiences of people living with mental illness and their families with private health insurance.The findings of the survey are supplemented with an analysis of 84 health plans in the top 15 states.

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.

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.

Shifting the balance in publicly-funded long-term care provision away from institutional care toward greater reliance on home and community-based services has been a federal goal for the past three decades -- a goal often referred to as "re-balancing" state LTC systems. This report explores inter-state variations in LTC expenditure and service use patterns, in terms of institutional and non-institutional services, and also by Medicaid LTC users' age and type of disability.

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.