Washington

The Medicaid Buy-In program is a key component of the federal effort to make it easier for people with disabilities to work without losing health benefits. This issue brief, the ninth in a series on workers with disabilities, examines the prevalence and characteristics of Medicaid Buy-In participants who leave the program as well as their participation status in other public programs and their employment outcomes after disenrollment.

The purpose of this report is fourfold: 1) to present a brief overview of the results of the Systems Change grants awarded from FY 2001 through FY 2004, 2) to describe the remaining challenges to community living that Grantees identified, 3) to provide Grantees’ recommendations for actions needed at the state and federal level to further improve their long-term care systems, and 4) to discuss the key lessons learned regarding factors that are needed to improve states’ long-term care systems.

Annual survey of all 50 States finds that during this time of recession the number of people on Medicaid is greatly increasing, as is the amount of money being spent on the program by individual States. Despite federal assistance from the American Recovery and Reinvestment Act (ARRA), this leads to further strain on already tight State budgets. This trend is expected to continue & States should be expecting a predicted increase of 6.3% on Medicaid spending in the 2010 fiscal year.

How can states use debit cards in their consumer-directed purchasing programs? The Sept 2009 Community Living Partnership TA Call addressed this financial management question. States have used pre-paid plans as part of their MFP and CLP grants. Review a matrix of pre-paid card companies and their methods for spending. Also included is a Proposed Procedure for Debit Card Purchases developed for the Veterans-Directed Home and Community Based Services Programs.

This updated resource provides a state-by-state look at wages and wage trends for PHCAs, the second fastest growing occupation in the country, and a key job title within the direct-care workforce. Review wages over a 9-year period. Prepared as a resource guide on wages for advocates and policymakers concerned with the direct-care workforce, the data underscore the problem of low and declining real wages for PHCAs, factors which contribute to workforce.

This issue brief examines the early successes and challenges of MFP. A 2008 survey of 29 states receiving MFP grants turned up several key findings, including that several hundred people have moved from institutional to community settings; that states are providing a broad range of services to facilitate transition; that housing issues for MFP participants are a major challenge for states; and that the severe economic downturn had not yet prompted states to scale back their efforts.

RTI is preparing a series of reports to document outcomes from the Systems Change grants. Divided into six parts, the first four provide an overview of the enduring improvements, continuing challenges, lessons learned, and recommendations of the 48 Research & Demonstration Grantees, organized by the four types of grants: CPASS, MFP, IP, & QA/QI. Part 5 provides summaries of the FTF Grants. Part 6 reviews the Respite for Adults and Children and Community-Based Treatment Alternatives for Children.

NASHP identified 10 leading state quality improvement partnerships - interrelated broad-based partnerships, mostly with public and private sector representation, which have long-term, statewide, systemic quality improvement strategic intent, and transparent agendas. This issue brief summarizes results of NASHP's full report that examines these partnerships in Colorado, Kansas, Maine, Massachusetts, Minnesota, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington.

This second report in a series focuses on how state variation in level of experience and infrastructure to undertake large-scale transition programs can affect implementation. The authors describe differences in strategies to 1) expand transition coordination capacity 2) locate appropriate housing 3) enhance long-term supports & services 4) change Medicaid HCBS programs/policies to ensure that those who transition can remain in the community after the MFP eligibility period ends.

Integrated Care Programs launched in five states in 2005 to coordinate acute and long-term services received by people enrolled in both Medicare and Medicaid. States were granted $100,000 and technical assistance focused on performance measurement, rate setting and risk adjustment, and administrative simplification. Here, state programs are evaluated, federal progress in integrated care is surveyed, and future considerations are identified.