Medicaid

A reader can use this report to better understand proposed rule changes regarding which TCM services are eligible for federal financial participation. Various perspectives on the changes are presented. Several tables and graphs illustrate past and projected TCM expenditures. Prompted by the Americans with Disabilities Act, CMS issued the interim rule in order to limit the growth of TCM costs. Current proposed legislation would delay rule implementation until April 1, 2009.

Find here a profile of enrollment, employment, and earnings in the 32 states with both a Medicaid Buy-In program and a Medicaid Infrastructure Grant (MIG) in 2006. Specifically, the report identifies how employment and earnings are influenced by the characteristics of participants and state programs.

CMS has proposed rule changes to implement Section 1915(i) of the Social Security Act. 1915(i) enables states to provide a prescribed set of HCBS to individuals that earn less than 150% of the Federal Poverty Level and require less than institutional levels of care. It does so without requiring waivers (as in 1915(c)), consumer eligibility for institutional care, or a cost savings demonstration. Further background information and instructions for comment submission are included.

This web-based resource helps Medicaid stakeholders allocate resources and demonstrate the business case for improving quality in health care. It is designed for programs that aim to more effectively manage the care of adults with disabilities and chronic conditions. Because the care of this population consumes nearly 70% of Medicaid expenditures, it represents a good opportunity to improve health outcomes, reduce unnecessary utilization, and control costs. Requires free registration.

The Deficit Reduction Act (DRA) of 2005 clarified which case management and targeted case management services are covered by Medicaid. The rule addresses concerns about improper billing of non-Medicaid services to the program by some states, while aiming to ensure comprehensive services that meet the needs of beneficiaries. These documents from CMS are meant to assist practitioners in understanding and abiding by these rules.

For states that receive federal funding, the Olmstead decision confirmed the obligation to serve individuals with disabilities in more integrated settings rather than provide supports and services in institutional settings. As states move forward with strategies to support community living for individuals with disabilities and promote the principles of person-centered planning, these tools and strategies provide complimentary opportunities to accelerate the achievement of inclusive outcomes.

In late 2007, the Center for State Health Policy surveyed 23 states that operate Medicaid waivers targeted to individuals with brain injuries. Data was obtained about the cost and number of individuals served by these waivers for the waiver years 2002 through 2006. Three states began waivers for those with brain injuries in 2002 or later, and 3 other states discontinued waivers in 2006. Every state except Arizona has multiple Medicaid 1915(c) home and community-based services (HCBS) waivers.

This study is intended to describe the nursing facility level of care determination processes in use by the states and to draw general conclusions from the data collected. When read in conjunction with the previous work in this area, this study will aid state staffs, CMS, and other parties interested in understanding how to improve post acute care assessment. The Appendix provide a brief description of data the state collects, the name of the assessment form, plus contact information.

This report details the state-by-state impacts of seven regulations issued by the CMS that would make major wide-ranging changes. Areas affected include cost limits for public providers, graduate medical education, outpatient hospital services, provider taxes, rehabilitative services, school administration and transportation services, and case management services. The website offers an interactive map showing how proposed regulations would impact each state.

The Kaiser Commission on Medicaid and the Uninsured supported this focus group project of adults with disabilities in 4 states, who are enrolled in Medicaid Consumer Directed Personal Assistance Services programs. This research was undertaken to learn about Medicaid enrollees’ experiences in the program and their opinions about key features of the program including recruitment issues and degree of responsibility over services. Ways to improve upon the programs were also identified.