Medicaid Waivers

Are we on the brink of a revival of interest in managed long-term care for people with intellectual and developmental disabilities? Four states’ experiences in experimenting with managed care are examined here, along with stakeholders’ views on these efforts. The report looks at goals, methodologies, and similarities and differences between programs. It concludes by looking at implications for other states.

Through this interactive training, family caregivers can learn about available resources and train themselves on how to deal with common challenges. Some of the resources featured are links to agencies and senior centers, care locator tools, and descriptions of helpful programs. Trainings cover how to recognize and prevent stress, improve communications with family members and service providers, and address conflicts.

The NQE provides free technical assistance on quality to states operating Medicaid HCBS programs. States can use the site to request technical assistance, pose questions to staff, engage online with other HCBS staff, and learn about upcoming events and NQE publications.

Via IHSS Plus, participants are able to receive certain expanded in-home services as part of Medi-Cal. Before, payments for these services were not matched by a federal contribution and were administered through a separate program. The analysis looks at implementation and service use in 2005, compares recipients’ outcomes and institutionalization rates to those in the original IHSS program, and complements the State’s evaluation and other research on paying family caregivers.

New York spends more than most states on Medicaid and long-term care. To understand why this is, the following traits are evaluated: demographics of residents over 65; poverty level; long-term care spending, budgets, and services; and quality of nursing home care. The findings identify a number of demographic and program factors likely contributing to the high rate of spending.

For many years, Section 1115 waivers have been used in the Medicaid program and the Children’s Health Insurance Program, to provide states an avenue to test and implement coverage approaches that do not meet federal program rules. While these waivers have facilitated important program evolutions over time, some have also raised issues. This brief reviews the experience of Section 1115 Medicaid and CHIP waivers and discusses issues for the Obama administration to consider for the future.

A central part of consumer direction is ability of the consumer to manage the budget and decide what to purchase. Evaluation data and anecdotes are given to show how this ability influences the outcomes of program participants.

How do finance institutions and HCBS influence asset building among persons with disabilities? This article explores patterns of and barriers to utilization of banking services using a case study of an Iowa credit union that has enrolled persons with disabilities under a HCBS waiver. Although not widely used by program participants, the credit union model provides savings opportunities to purchase goods and services that facilitate independent living.

The question posed in the title is answered by analyzing state spending data from 1995-2005. The report shows that, for two distinct populations receiving long-term care services, spending growth was greater for states offering limited noninstitutional services than for states with large, well-established noninstitutional programs. Expansion of HCBS appears to entail a short-term increase in spending, followed by a reduction in institutional spending and long-term cost savings.

The trends in state Medicaid HCBS programs, target groups, participants, and expenditures are summarized and policy recommendations are made. The paper shows the progress in providing Medicaid HCBS but also identifies many current problems and policies. Inequities in access to services and limited funds result in unmet needs. Cost issues have been a primary focus of policy makers and quality problems are largely not addressed.