Medicaid Waivers

This bulletin reviews policy when Medicaid funding is available for certain administrative costs related to activities conducted by state Long Term Care Ombudsman (LTCO) programs that benefit the state's Medicaid program. It also summarizes the basic requirements for Medicaid administrative claiming of LTCO program activities and provides a link where states and LTCO programs can find more information regarding specific program activities that may be eligible for Medicaid administrative funding.

This summary draws attention to some of the most important aspects of CMS’s recently released guidance for states and stakeholders on the use of managed care for long-term services and supports (MLTSS) as well as transitioning LTSS providers into managed care systems and developing MLTSS programs. CMS identified 10 important elements that should be incorporated into managed LTSS and this document can assist consumers and their representatives in understanding these elements.

This issue brief uses the most recent comprehensive data, from 2009, to examine the characteristics and costs of dual-eligible beneficiaries. The report also examines the different payment systems that Medicare and Medicaid use to fund care for dual-eligible beneficiaries and recent efforts at the federal and state levels to integrate those payment systems and coordinate the care between both programs. Given the high cost of dual-eligibles, legislative solutions are reviewed.

In an effort to assist state agencies in planning for the specific behavioral health needs of emerging populations in their state, this toolkit provides state and national estimates of behavioral health disorders and program utilization, as well as step-by-step instructions to generate projections of health benefits, services and providers that will need to be addressed in the future. This resource can be helpful for mental health and substance use agencies, health plans, and Medicaid agencies.

This policy brief provides a comparison of CMS’ finalized memoranda of understanding with California, Illinois, Massachusetts, Ohio, and Virginia to test a capitated model and with Washington to test a managed fee-for-service (FFS) model to integrate care and align financing for dual-eligibles. These 2013 demonstrations will introduce changes in the care delivery systems and will test a new system of payments and financing arrangements among CMS, the states and providers.

CMS created a financial alignment demonstration to better promote coordinated care for dual-eligibles. The fee-for-service managed care model has received less attention than capitated managed care. However, this model could be useful in states or regions where traditional managed care organizations are not well established or do not function well. This brief makes some assessments of the advantages and difficulties of the model and identifies elements necessary for successful implementation.

CMS has released two important documents that outline essential elements of MLTSS programs that are in line with current best practices. The first document summarizes these essential elements and the second provides guidance for incorporating these essential elements into MLTSS programs operating under section 1115 or 1915(b) authorities. These standards will be used when CMS reviews states’ design, implementation and operation of MLTSS programs for approval and ongoing quality assurance.

Money Follows the Person (MFP) federal grants are provided to states in order to assist older adults and people with disabilities in transitioning from nursing facilities to home and community based settings. A history and current state of MFP are offered. This report provides an overview of how MFP has helped states to rebalance their LTSS programs and provides next steps and an outlook for the future of MFP or similar programs once the demonstration project’s funding has run out.

A survey of state aging, disability and Medicaid agencies was conducted in 2012, in order to better understand challenges and concerns for funding and providing quality LTSS. Five common themes were identified in this report, including staff turnover and reductions during a sluggish recovery of state budgets. Other findings include an overall expansion of home and community-based services, LTSS transformation and reduced funding and high demand for non-Medicaid aging and disability services.

The Affordable Care Act authorized the Medicaid Health Home State Plan Option, which allows states to design health homes to provide comprehensive care coordination for Medicaid beneficiaries with chronic conditions. States will receive enhanced federal funding to support the rollout of this new integrated model of care. This link directs to the Health Home Resource Center that provides technical assistance services for states as they submit their proposals for these health homes to CMS.