Medicaid Waivers

This entry presents data on Medicaid 1915(c) Home and Community-Based Services (HCBS) waiver expenditures from Federal Fiscal Years 1999-2004. As in previous years, information is classified for each individual HCBS waiver by the target population served in order to present information on the distribution of HCBS waiver expenditures across long term care populations. Tables include waiver spending by target population; growth in spending; expenditures by state; distribution of expenditures.

The State of South Carolina implemented a state-wide automated monitoring system whose real time data allows for monitoring & verification of the providers delivering services under the state's home and community-based services waivers. The toll-free number allows providers to check-in and check-out as they deliver services in a participant's home, while the database inferfaces with claims data to minimize fraudulent billing. The database has empowered waiver service recipients.

South Carolina developed a simplified provider agreement to make Medicaid enrollment easier for providers that normally do not provide Medicaid services. The State piloted the agreement in an Independence Plus Medicaid Home and Community-Based Services Waiver and in a Nursing Home Transition Grant. The six-item agreement contains only the minimum federal requirements for Medicaid providers and can allow Medicaid participants to receive services, equipment, etc. from non-traditional providers.

Surveying Maryland’s 3,180 dual eligibles who are enrolled in hcbs waiver programs, the author finds that the end-of-2005 transfer of prescription drug coverage from Medicaid to Medicare under the Medicare Modernization Act of 2003 could put these beneficiaries in jeopardy. The experience in MD is likely to be typical for other states. The paper recommends a number of federal policy remedies, including 90-day prescriptions, using open or shared formularies, & lengthening the enrollment period.

The Centers for Medicare & Medicaid Services (CMS) invite proposals for grants in three categories: a. Family-to-Family Health Care Information and Education Centers b. Systems Transformation Grants c. Aging & Disability Resource Centers. In FY 05, during the consolidated appropriations process, Congress appropriated $39 million to fund a new round of RCSC grants. States and other eligible organizations, in partnership with their disability & aging communities, may submit proposals until 7/7/05.

This is the first in a series of newsletters produced at the Exchange to provide assistance to our CMS Real Systems Change grantees. This newsletter is produced biannually. Topics include: 2004 Real Choice Systems Change Grant Solicitation; Real Choice Systems Change Grant Summary Chart; Clearinghouse for The Community Living Exchange Collaborative. A table includes the types of Real Choice Systems Change Grants that the Community Living Exchange Collaborative provides technical assistance to.

The Formative Evaluation of the Real Choice Systems Change Grants evaluates how the Systems Change grantees are progressing towards meeting their goals. The Formative Evaluation identifies problems faced by the grantees and ways that they deal with the problems. This document provides summary information about each of the FY2004 Grantees.

This document describes the releationship between WV Real Choice Grants and the Olmstead Plan. The document contains a table showing all grants awarded to the state. The table illustrates the activities of the Real Choice Systems Change for Community Living grants and shows how the programs are closely aligned with the West Virginia Olmstead Plan. This strong relationship is the result of collaboration between the Olmstead Coordinator and other state partners and stakeholders involved.

The CMS Systems Change conference was February 28-March 2, 2005. Presentations from the 2005 sessions are available in both PDF and text formats. Topics range from ideas on sustaining systems change, employment services, Medicaid, integrating quality, policy implications and barriers to providing services. Full titles are listed in the keywords section.

This recent Health Affairs article presents the latest program trends in the three Medicaid home and community-based services programs (waivers, home health, & state-plan personal care) and reports a national survey of cost control policies used on waiver programs in 2002. The findings show slowing annual rates of participation growth on individual programs, widespread use of cost controls on waivers including waiting lists, and the persistence of large interstate variations.