Medicaid Waivers

The author focuses on Medicaid and Medicare in offering healthcare reform suggestions. Both legislative and administrative actions are proposed regarding eligibility and enrollment, access to services, program management and delivery systems issues, and financing. Several options relate to HCBS, such as protecting spouses of the medically needy, expanding eligibility for SSI-related groups, and issuing further guidance on waiver waiting lists.

The Older Americans Act (OAA) requires states to submit a Plan on Aging every 1-4 years focused on reforming long-term care to help keep older people independent. Arkansas presents information on their organization, programs, goals, funding, and people served. Their plan covers areas including Cash & Counseling, Money Follows the Person, transportation planning, disaster preparedness, and others.

In 2005, VT became the first state to commit to a federal Medicaid funding cap in exchange for expanded eligibility definitions and access to home and community-based services under a Section 1115 waiver. Case studies and interviews are used to present key findings from the program. Key design features are also presented. Finally, future issues within VT and other states that might emulate the program are discussed.

This report analyzes Alaska’s LTC system and makes recommendations for reform. The report provides a discussion of the opportunities and challenges of the various Medicaid authorities for funding LTC, including new DRA options. Recommendations include establishing mechanisms for controlling costs; streamlining access and coordinating assessment processes; developing a quality management strategy that complies with CMS requirements; and increasing consumer direction.

This report provides a summary of how long-term services and supports (LTSS) are financed and describes factors that contribute to uncertainty of the future costs for LTSS, including changes in how LTSS will be delivered. Three projections of future LTSS spending for senior populations under different scenarios are offered. These scenarios differ based on projecting the number of people with varying functional limitations and the resulting need for varying degrees of LTSS.

This is the eighth consecutive year that state Medicaid officials were surveyed to track program trends. In addition to data on expenditures and enrollment, the report outlines policy enhancements and restrictions in all states and the District of Columbia. The resource ends with a discussion of current key Medicaid issues and perspectives of State Medicaid Directors.

In an effort to address integration across CMS Home and Community-based Services Programs, CMS worked with its National Quality Contractor to develop an this matrix. The Grid highlights specific quality requirements across HCBS program authorities that include program standards, measures, accountability, and sources of financing for quality activities. The tool is expected to be a helpful resource for planning purposes and for providing technical assistance to states and researchers.

The GAO conducted a study in which they examined the extent to which states (1) include, as a critical incident, deaths among individuals with developmental disabilities in waiver programs; (2) have basic components in place to review such deaths; and (3) have adopted additional components to review deaths. The report outlines six basic mortality review components. Review the two key recommendations offered to CMS.

The purpose of this report is to inform the efforts of states that are trying to develop and improve QA/QI systems by describing and analyzing how selected Systems Change Grantees went through this process. The initiatives examined fall into six categories: administrative technology and information technology; standards for services; discovery; remediation; workforce; and public information.

Medicaid waivers funds can be used to support self-employment, but may not be used directly to fund the development of a business. This factsheet provides answers to questions about how to leverage waivers supports for self-employment while complying with these regulations. It also outlines eligibility requirements and presents short case studies.