Medicaid

This brief describes the evolution of beneficiary-managed home and community-based services since the original demonstration and provides an overview of state activity as of January 2006. The Deficit Reduction Act of 2005 gives states the option to use this model for an expanded range of home and community based services in their state Medicaid plans without having to obtain a waiver.

This report and tables present Medicaid 1915(c) Home and Community-Based Services (HCBS) Waiver expenditures data from Federal Fiscal Years 2003 through 2008. Each HCBS waiver is classified by population served in order to show the distribution of expenditures across long-term care populations. This report includes new target population categories to identify waivers that target particular developmental disabilities such as intellectual disabilities and autism spectrum disorders.

The proportion of long-term care spending that goes to institutional care has been dropping over time, from 81 percent in 1995 to 63 percent in 2005. However, there remains significant concern that many people who would prefer to receive care in the community are unable to do so because of what has been termed the ‘institutional bias’ of Medicaid. This report discusses the issues surrounding efforts underway to shift the balance toward HCBS in the state of Pennsylvania.

Developing HCBS alternatives to institutional care has been a priority for many state Medicaid programs over the last three decades. While the majority of long-term care dollars still go toward institutional care, the national percentage of spending on HCBS has more than doubled from 19 percent in 1995 to 41 percent in 2007. This article presents a summary of the main trends to emerge from the latest (2006) expenditures and participant data for the three main Medicaid HCBS programs.

The CMS website has been updated with the new 508 compliant MSIS Medicaid eligibility and claims tables for federal fiscal years 2005 through 2008 for 31 states. Individual or groups of tables may be selected using the identified dynamic list options. The standard MSIS fiscal year tables will be updated periodically as additional states submit their data for the full fiscal year.

Leading health reform proposals in both the House and Senate include a Medicaid expansion to help eliminate state variation in the current program and to broaden health coverage. Because Medicaid is jointly administered and financed by states and the federal government, changes will have direct impact on states. While health reform legislation could have many implications, this brief highlights some of the potential benefits and costs associated with Medicaid expansion in the reform proposals.

This fact sheet discusses the status of Medicaid and state budgets in light of the continuing recession and the federal fiscal relief provided to state Medicaid programs through the American Recovery and Reinvestment Act (ARRA). The ARRA money has helped address budget shortfalls, preserve Medicaid eligibility and soften program cuts. But ARRA funds are set to expire on Dec. 31, 2010, which may prompt some states to turn to cost-saving measures such as restrictions on Medicaid eligibility.

The population is aging & the demand for long term care and services at home is increasing. Medicaid is the most critical program for individuals who are aged & disabled because it pays for almost 46% of all nursing home care & 38% of home health. Medicaid HCBS have been the focus of efforts by the federal & state governments to expand access for several reasons. The focus of this article is to examine issues of access, cost, & quality for Medicaid HCBS programs and to suggest policy changes.

This brief summarizes lessons in offering more home and community-based services from states at the forefront of the effort. It describes current options for state Medicaid programs and draws on interviews with state officials to provide details about specific policies and procedures in states.

This brief highlights key strategies to address financing, program administration and community workforce challenges that key experts, federal and state officials and advocates believe must be overcome to expand access to home and community-based services (HCBS). Among the key ideas drawn from a working group discussion at the Foundation are the benefits of providing additional federal financing to states to provide Medicaid HCBS and to administer these benefits.