Medicaid

Spending on HCBS has grown in recent years, but little is known about what effect alternatives have on overall costs. An analysis of state data from 1995-2005 shows that for two population groups, spending growth was greater for states offering limited noninstitutional services than for states with large, well-established noninstitutional programs. Expansion of HCBS appears to entail a short-term increase in spending, followed by a reduction in institutional spending and long-term cost savings.

Guidance is offered for states in interpreting the sections of ARRA that impact Medicaid and CHIP. Program elements affected include tax credits, income used to calculate benefit levels, Federal Medical Assistance Percentage, Transitional Medical Assistance, protections for Native Americans, and transfers of assets. The attachment lays out program changes organized by ARRA section.

The brief explains how Medicaid works in today’s health care system and answers some of the key questions of how Medicaid fits into broader health reform efforts. Information is given in question and answers. The authors offer their opinion on how eligibility, benefits, finance, and other characteristics of the program should be changed.

Three researchers use data from the Survey of Income and Program Participation to estimate the expense of a mandatory personal assistance services (PAS) benefit under Medicaid for persons with low incomes, low assets, and significant disability. They conclude that the cost would be much lower than estimated by the Congressional Budget Office. They also argue that this step would help eliminate the institutional bias of Medicaid.

New York has 12 long-term care (LTC) programs: two residential and ten community-based. Data from all are compiled here with the goal of informing policymaking and addressing challenges to the state’s Medicaid LTC programs. An overview of current programs and a snapshot of data such as enrollment and spending are also presented. The first chapter takes a look at the whole system and four other chapters offer data on the largest programs in terms of people served and dollars spent.

The Chartbook documents trends in enrollment, earnings, employment, medical expenditures, and consumer experiences and satisfaction since Kansas began its Buy-In program. Summarized are survey and administrative data that document increased earnings and taxes paid over time by participants, decreased medical expenditures for those continuously enrolled, and improved quality of life and financial status.

Here is a snapshot of the program , seven years after implementation. The report introduces the grants, their assessment process, profiles funding recipients, and measures how well the program protects workers’ benefits and increases employment. Finally, recommendations for improving outcomes are provided.

Via IHSS Plus, participants are able to receive certain expanded in-home services as part of Medi-Cal. Before, payments for these services were not matched by a federal contribution and were administered through a separate program. The analysis looks at implementation and service use in 2005, compares recipients’ outcomes and institutionalization rates to those in the original IHSS program, and complements the State’s evaluation and other research on paying family caregivers.

New York spends more than most states on Medicaid and long-term care. To understand why this is, the following traits are evaluated: demographics of residents over 65; poverty level; long-term care spending, budgets, and services; and quality of nursing home care. The findings identify a number of demographic and program factors likely contributing to the high rate of spending.

Money Follows the Person (MFP) programs only target 0.9% of the people that could be eligible for transitioning out of institutions each year. However, there is a potential to increase rates to 15-40% annually depending on quality of program implementation, who is targeted, and how successful states are in overcoming barriers to transitioning high-needs people. The report looks at grantee states’ potential for accomplishing this rate increase.