Consumer/Participant Direction

This policy brief provides a comparison of CMS’ finalized memoranda of understanding with California, Illinois, Massachusetts, Ohio, and Virginia to test a capitated model and with Washington to test a managed fee-for-service (FFS) model to integrate care and align financing for dual-eligibles. These 2013 demonstrations will introduce changes in the care delivery systems and will test a new system of payments and financing arrangements among CMS, the states and providers.

CMS has released two important documents that outline essential elements of MLTSS programs that are in line with current best practices. The first document summarizes these essential elements and the second provides guidance for incorporating these essential elements into MLTSS programs operating under section 1115 or 1915(b) authorities. These standards will be used when CMS reviews states’ design, implementation and operation of MLTSS programs for approval and ongoing quality assurance.

Money Follows the Person (MFP) federal grants are provided to states in order to assist older adults and people with disabilities in transitioning from nursing facilities to home and community based settings. A history and current state of MFP are offered. This report provides an overview of how MFP has helped states to rebalance their LTSS programs and provides next steps and an outlook for the future of MFP or similar programs once the demonstration project’s funding has run out.

A survey of state aging, disability and Medicaid agencies was conducted in 2012, in order to better understand challenges and concerns for funding and providing quality LTSS. Five common themes were identified in this report, including staff turnover and reductions during a sluggish recovery of state budgets. Other findings include an overall expansion of home and community-based services, LTSS transformation and reduced funding and high demand for non-Medicaid aging and disability services.

Ethnic minorities and LGBT older adults will continue to become more represented among the older adult population. A lifetime of discrimination has often adversely affected LGBT elders of color in a myriad of ways, including greater likelihood of financial instability and heightened health disparities. This report offers policy solutions to support the wellbeing of this growing population. Policy solutions include strengthened outreach and community supports to LBGT elders of color.

A representative sample of 1,019 adults ages 40 or older were interviewed regarding their experiences and beliefs about their need for long-term care services, what such care would cost, and how such issues fit into their concerns about growing older. This report outlines survey findings. Findings include, 58% of participants underestimate the cost of nursing homes, 41% have discussed long-term care preferences with family and 51% support a government sponsored long-term care insurance program.

What They Did. Did It Work? How They Did It and Adoption Considerations. These are all the questions that the Policy Innovations Profile will answer about Cash & Counseling. As a voluntary alternative to traditional agency-delivered home care, a joint public-private program gives Medicaid enrollees a monthly allowance for home care and related services that they can spend at their own discretion. Review the evidence. tools and resources and otherimplementation tips.

In this case study, the authors examined the decisions and experiences of parents/guardians who directed supports and services for an adult with significant intellectual and developmental disabilities (SIDD). Respondents included the parents/guardian of the adult as well as others in the circle of support identified by the parents/guardians.

Review this one-stop resource created by a team of agencies to help providers better understand, develop, and sustain participant-directed programs. The information is applicable whether funded by the Older Americans Act, Veterans Health Administration, State funds or other. The toolkit has two parts: one devoted to designing, managing and evaluating programs; the second on Financial Management Services (FMS). Resources include articles, forms, webinar recordings, state examples and charts.

Agency with Choice (AwC) is a model of Financial Management Services (FMS) in which an agency and a participant are joint employers of workers who provide service to the participant. This paper presents the benefits, challenges, and risks of AwC FMS and puts forth the National Resource Center for Participant-Directed Services (NRCPDS)’s list of key components for AwC FMS to be considered participant-directed, providing a model for consistency in future implementation of AwC FMS.