Medicaid Waivers

A final rule that would allow more Medicaid beneficiaries to be in charge of their own personal assistance services, including personal care services, instead of having those services directed by an agency, was published in the Oct 3, 2008 Federal Register. The rule, effective Nov. 3, 2008, guides states that wish to allow beneficiaries who need help with activities of daily living to hire, direct, train or fire their own personal care, workers including qualified family members.

A recent trend in health care has been the increasing integration of behavioral health services into primary care settings. This paper discusses the benefits of such integration and the role of safety net primary care providers as behavioral health providers within the Medicaid program. The authors focus on organizational structure and reimbursement models in analyzing how four state programs achieve this integration.

This paper examines the use of research, demonstration, and program waivers as vehicles for innovation in the delivery and payment of health care and long-term care. It summarizes the context of the creation of the programs and reviews their legal underpinnings. It also analyzes the dynamics between state and federal authorities. Finally, the paper examines the impact of the Deficit Reduction Act of 2005 on the need for or desirability of waivers.

This memorandum and tables present data on Medicaid 1915(c) Home and Community-Based Services (HCBS) waiver expenditures from Federal Fiscal Years 2002 through 2007. Each HCBS waiver is classified by population served in order to show the distribution of HCBS waiver expenditures across long term care populations.

Find here examples of communications used to answer questions about eligibility and the application process for waiver programs. The first handout summarizes the three levels of financial eligibility and strategies for helping an individual maintain benefits. The second resource, a training presentation, provides this information in more detail and uses an anecdotal character to walk through the requirements. Finally, the chart illustrates basic eligibility requirements in a simple chart.

This issue brief reviews how new rules issued by CMS governing Medicaid coverage of targeted case management (TCM) services would affect people with complex health needs receiving home and community-based services. The author finds that the availability of several important services and strategies used in TCM would be significantly reduced. New record keeping requirements would also increase administrative burdens and costs.

The authors identified trends regarding the use of 1915(c) waivers to buy assistive technology (AT). They examined participation and expenditures as well as differences in provision between elderly people and individuals with developmental disabilities. Results showed that the use of waivers to fund AT is growing, but more slowly than the overall waiver program. Also, there are significant differences in provision between people with disabilities and older adults as well as between states.

In order for Oregon to balance its two-year budget for 2001-03, the Seniors and People with Disabilities Division (SPD) in the Department of Human Services was mandated to reduce LTC spending by nearly 30%. This paper analyzes the 2003 cuts to Oregon’s Medicaid long-term care (LTC) system, the impact of those cuts on a well-developed home and community-based services (HCBS) system, how the state has responded, and lessons that could be learned from its response.

In late 2007, the Center for State Health Policy surveyed 23 states that operate Medicaid waivers targeted to individuals with brain injuries. Data was obtained about the cost and number of individuals served by these waivers for the waiver years 2002 through 2006. Three states began waivers for those with brain injuries in 2002 or later, and 3 other states discontinued waivers in 2006. Every state except Arizona has multiple Medicaid 1915(c) home and community-based services (HCBS) waivers.

The purpose of this compendium is to establish baseline knowledge of the scope of assistive technology and home modification services that states make available to Medicaid-eligible adults. This study provides federal and state policymakers with basic information to inform planning and policy development. It also provides other stakeholders, including consumers, with valuable information about Medicaid State Plan and HCBS waiver.