Medicaid Waivers

This report describes grant activities in three major LTC systems areas: Access to Long-Term Care Services and Supports, Services, Supports, and Housing, Administrative and Monitoring Infrastructure. For each of the focus areas the report describes Grantees’ accomplishments, illustrates the challenges and discusses the consumers’ role in the implementation and evaluation of activities. The report uses information provided during the reporting period October 1, 2004 to September 30, 2005.

This memorandum and tables present data on Medicaid 1915(c) Home and Community-Based Services (HCBS) waiver expenditures from Federal Fiscal Years 2000 through 2005. Each individual HCBS waiver is classified by population served in order to show the distribution of HCBS waiver expenditures across long term care populations.

This memorandum presents data on Medicaid long-term care expenditures in Federal Fiscal Year 2005 (Sept 2004-Sept 2005). The accompanying tables present data on Medicaid Expenditures for Long-Term Care services from 1993-2005. Data included for Nursing Homes, ICF-MR, Personal Care, HCBS Waivers, Home Health, Home Care, Inpatient Hospital Care, Inpatient DSH, Inpatient Mental Health, Mental Health DSH, Medicaid Managed-Care, Prescribed Drugs, Long-term Care, Targeted Case Management and PACE.

This CMS letter provides a status update on the web-based version of the application for 1915(c) Home and Community Based waivers, the revised paper version of the waiver application (Version 3.3) and the evaluation of it, as well as the 373 S and Q.

This paper discusses the activities of 11 grantees and the program and policy issues they have encountered. The paper’s primary purpose is to provide information that states and stakeholders will find useful when planning or implementing consumer-directed initiatives, whether through solely state-funded programs or the Medicaid program. In particular, the report highlights program and state and federal policy challenges and how Grantees are addressing them.

The CMS Systems Change conference, Transforming Systems: Keys to Success was held April 10-12 in Baltimore. Presentations from the 2006 sessions are available in both PDF and text formats. Topics range from ideas on system transformation, stakeholder involvement, coalition building, strategic planning, sustaining systems change, and the Deficit Reduction Act. Full titles are listed in the keywords section.

On Monday May 8, 2006, CMS hosted a New Freedom Initiative Open Door Forum that focused on Section 6086 of the Deficit Reduction Act. During the call CMS reviewed the differences between how home and community based services can be provided through the State plan and the more traditional 1915c waivers. This chart summarizes CMS’s overview of the DRA provisions.

This issue brief explores the continuing evolution of the Medicaid program on several fronts. It discusses the benefits and cost-sharing flexibility that is included in the Deficit Reduction Act and examines the implications for states, beneficiaries, and providers. The paper also explores recent trends in section 1115 waiver development and considers the use of waivers as a vehicle for restructuring Medicaid financing systems and for testing completely new approaches to health care delivery.

This summary of the Home and Community Based Services (HCBS) State Plan Amendment (SPA) option is based on a review of the Deficit Reduction Act (DRA) and discussion from the April 3, 2006 conference call with CMS staff and Real Choice grantees. The content reflects the Rutgers/NASHP TA collaborations understanding of the legislation and questions raised by grantees. The intent is to highlight what is known about the DRA and some questions about how it will affect States that elect this option.

Beneficiary-managed individual budget model had its origins in the Cash & Counseling Demonstration. This brief describes the evolution of the model since the original demonstration and provides an overview of state activity. Although Medicaid waivers have been required for individual budget model programs to date, the Deficit Reduction Act gives the option to use this model for an expanded range of home and community based services in the Medicaid plans without having to obtain a waiver.