Medicaid Waivers

The information in this paper supports the President's New Freedom Initiative initiative by describing how a state might use the Health Insurance Flexibility and Accountability (HIFA) waiver option under Section 1115 authority to improve access to community-based services for persons with mental illness. These services can include basic health care coverage, enhanced community-based supports, and provisions to encourage the use of employer-sponsored insurance (ESI).

This topic paper summarizes how states can use Medicaid to pay for most institutional transition program costs on a permanent basis as a result of policy change since 2000. It also describes how states are currently using Medicaid HCBS Waivers to pay for community transition services-temporary supports people need when trying to move such as housing deposits, utility set-up fees, and furniture.

This brief focuses on one consumer-direction model within the Family Care program-the Agency with Choice model-in which a \"co-employment agency\" serves as the Employer of Records and the consumer acts as the Managing Employer. In the other consumer-directed model, the consumer takes on all employer responsibilities. Slightly more than one in five Family Care members choose the co employment option, demonstrating how a managed care program can incorporate consumer direction.

Kansas operates four Medicaid waivers that allow program participants to self-direct their care. These programs permit participants to hire a worker or their choice and choose an organization to act as the Employer of Records for their worker. The programs are noteworthy because of the large number and wide variety of organizations that fulfill this function and the many different ways in which they serve their clients, providing a high level of choice to participants and their representatives.

Discusses options for combining Medicaid long-term care funding and expanding the scope of long-term care services. The call was organized in response to a need identified by a grantee and included states that were available and had relevant experience with the questions being raised.

Collaboration between state Medicaid and Mental Health programs has varied greatly across states and administrations. The purpose of this paper is to identify and describe the basic elements of successful collaboration through 1) a review of the literature on collaboration, and 2) a description of collaboration in two states. The state examples highlight the mechanisms through which successful collaboration occurs and describe the types of activities in which collaborating agencies engage.

Draft Version 3.0 of the1915c Medicaid HCBS Waiver Application and the “Instructions, Technical Guide and Review Criteria.” are now available. These materials provide guidance for completing the application, background information on program requirements and assurances, an explanation of options available to states and review criteria. States interested in using the draft application prior to 1/’06 should notify your CMS Regional Office which will provide you with the most current -Version 3.2.

States that are trying to streamline policies and paperwork to help people receive long term care and support in community settings are re-examining the processes they use to determine eligibility for programs. This technical assistance document focuses on one of those processes, determining “level of care”, and provides clarification about federal requirements for physician involvement.

This issue brief will present several approaches that attempt to tackle the underlying challenge of reducing nursing facility utilization and expenditures. These range from modifying the nursing facility reimbursement methodology; to converting nursing facilities to assisted living centers, paying nursing facilities to take beds off-line, and using capitated managed long-term care; to approaches with theoretical promise that have yet to be adopted in any state.

The Compendium contains basic information about each of the Real Choice Systems Change Grantees. The Compendium will help you learn more about how these grants will be used to allow more people of all ages with a disability or long term illness to live and participate in their communities. Real Choice Systems Change Grantees will also find the Compendium useful to identify other Grantees with similar goals and activities. The fourth edition of the Compendium replaces all previous editions.