Medicaid

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.

Integral to the coverage framework laid out in the reform law is a dramatic expansion of the Medicaid program. This primer provides key information about the program today, including a definition of what it is, who and what services are covered, Medicaid expenditures and how they are financed, and information of how health reform reshapes the program for the future.

According to the authors, transforming Medicaid’s LTC programs is an urgent priority given states’ challenging fiscal environment. Based on this paper’s model, more than 35 percent of a state’s budget will be needed for Medicaid by 2030, of which half will be for LTC services. The brief examines Medicaid expenditures for LTC, in both institutional and community settings, and presents ideas for consideration for states to transform their programs to help address budget constraints.

The Affordable Care Act (ACA) includes the extension of the MFP Demonstration Program for an additional 5 years. This letter provides background about the MFP Demonstration Program, explains improvements made by the ACA, details how the ACA will impact current MFP grantees, and provides preliminary information for non-participating States that may be interested in pursuing new funding.

Find a concise summary of new opportunities under the health reform law for states to balance their Medicaid long-term care delivery systems by expanding access to Medicaid HCBS programs. The brief outlines key provisions of the new law that expand HCBS benefit options, broaden financial and functional eligibility criteria, and provide additional financial incentives for states to further shift their Medicaid long-term services budgets to non-institutional settings.

Review recommendations offered for maximizing the new Center for Medicare and Medicaid Innovation’s effectiveness in promoting reforms to improve the quality and value of care, while helping achieve health reform’s goals of more efficient, coordinated, and effective services. Suggestions include implementing a variety of payment reform initiatives, including global and bundled payment, and encouraging the implementation of innovative models developed by states and the private-sector.

Find national and state by state estimates of the increases in coverage and the associated costs compared to a baseline scenario without the Medicaid expansions in health reform. Findings show there will be large increases in coverage and federal funding in exchange for a small increase in state spending. Since it is impossible to predict the behavior of each state, the analysis examines two participation rate scenarios differing in the strength of outreach and enrollment efforts.

Changes CMS is making in the State plan amendment (SPA) review process are explained in this letter. CMS has identified a process that will expedite the review of SPAs while ensuring that CMS and States resolve other questions that may arise. States will now have the option to resolve issues related to State plan provisions that are not integral to the SPA through a separate process. Several examples based on actual State plan issues are included.