Medicaid

Medicaid finances nearly half of all LTSS spending. Review an update to existing data on Medicaid financial eligibility standards for nursing home and HCBS waiver services for older persons and adults with disability. 2009 data were obtained on state selection of optional pathways for eligibility, income and asset standards, cost-sharing and other post-eligibility financial requirements. A copy of the survey instrument and accompanying letter to state Medicaid Directors are included.

State-authorized health plans whose members are qualified to receive both Medicare and Medicaid benefits face administrative challenges. This study examines care management practices in four health plans that serve persons who are dually eligible. The authors describe how health plans operationalize their integrated care management approaches and identify a common framework for integrating care.

A number of health reform provisions give states additional options for financing HCBS services. This brief analyzes scenarios whereby states, which have significant roles in implementing many aspects of the ACA, might implement a combination of new Medicaid state plan options, enhanced Medicaid matching payments, and demonstration projects to expand HCBS care. In determining whether to adopt these options, states will assess whether they improve upon the current Medicaid authorities they use.

Many low-income individuals with severe mental illness leave state institutions without health insurance and therefore without financial access to the treatment they need to live successfully in their communities. Read an evaluation of Oklahoma’s efforts to develop and implement a model program to ensure that eligible individuals with mental illness were enrolled in Medicaid at discharge from state prisons and institutions for mental diseases.

What are some of the essential components of Medicaid long-term care programs? This brief, geared towards people working in Medicaid or disability employment, discusses payment for long-term care, range of services, administration, eligibility, functional assessment and rebalancing of long-term care systems. Also find examples of how some states have incorporated aspects of long-term care services and supports (LTSS) into their Medicaid Buy-In (MBI) programs.

Find an analysis of changes the new law makes to Medicaid, Medicare Part D and Medicare Advantage that impact low income individuals in particular. There is also a brief discussion of the coverage expansion and its potential impact on this population. This brief is part of a series of issue briefs prepared by NSCLC which discuss the impact of the new law on low income older adults.

Millions of low-income adults without children who currently cannot qualify for coverage, as well as many low-income parents and children now covered through the CHIP program will become eligible for Medicaid. These programs are expected to cover an additional 16 million people by 2019. This brief provides the details of the benefit and cost-sharing rules that will govern the coverage available to newly-eligible adult Medicaid beneficiaries.

This report is the latest in a series of annual reports that present expenditures data for Medicaid Home and Community-Based Services (HCBS) waivers authorized under Section 1915(c) of the Social Security Act. Table 1 presents reported Federal Fiscal Year (FY) 2009 expenditures for each HCBS waiver in effect during that year. Table 2 presents HCBS waiver expenditures data from FY 2004 through FY 2009 by state. The remaining tables present data according to the populations served in waivers.

This report is the latest in a series of annual reports on Medicaid long-term care expenditures. Table 1 presents national expenditures data for FY 1997–FY 2009. Tables A through T present state-by-state expenditures data for FY 2004–FY 2009 for specific categories of service. Tables U, V, and W present the distribution of each state’s LTC expenditures among institutional and community-based services.

Innovative applications of technology in Medicaid are highlighted in this series of profiles from varying states. Louisiana, a pioneer in using “Express Lane Eligibility” (ELE) is examined in this report. ELE allows Medicaid and CHIP agencies to use eligibility findings from other public programs to identify, enroll, and recertify participants. Despite a 12% reduction in the Medicaid workforce over the last two years, the volume and quality of service has remained consistent.