Policy alerts, briefs, letters & papers

This paper provides a brief overview of the direct-care workforce in the U.S. It uses PHI research to detail many of the issues facing the workforce, including low wages, inadequate benefits, and a lack of career advancement opportunities.

An Accountable Care Organization (ACO) is a provider-run organization in which the participating providers are collectively responsible for the care of an enrolled population. This brief examines the existing Medicaid payment and care delivery landscape in states undertaking Medicaid ACO initiatives to gain insights into how ACOs fit into states’ Medicaid programs, and to identify important differences between Medicaid ACOs and ACOs in Medicare and the private insurance market.

Section 1115 waivers provide states an avenue to test new approaches in Medicaid that differ from federal program rules. Waivers can provide states significant flexibility in how they operate programs and can have a significant impact on program financing. As such, waivers have important implications for beneficiaries, providers, and states. This brief provides an overview of Section 1115 waiver authority, the waiver approval process, and recent waiver activity and discusses the implications.

In recent years, the Social Security Administration (SSA) has placed a greater emphasis on increasing employment among people who receive federal disability benefits while also reducing their reliance on those benefits. SSA’s efforts have led to a growing interest among policymakers in exactly how many disability beneficiaries forgo cash benefits because they are working and how long they are able to remain off cash benefits. This brief summarizes findings from a longer report.

This brief explains how Medicare beneficiaries become eligible for Medicaid, provides national & state-by-state data on enrollment, & examines national & state-specific data on Medicaid spending for dual-eligible beneficiaries by service & eligibility group. The Foundation also has a collection of resources on dual-eligible beneficiaries, including basic facts & data, and analysis & explanation of specific issues, which include provisions of health reform affecting dual-eligible beneficiaries.

Program provides guidance for a three-year effort to use OSHA outreach & inspections to reduce specific occupational hazards in nursing & residential care facilities. The Department of Labor identified the following hazards: Exposure to blood & other potentially infectious material; Exposure to other communicable diseases; Ergonomic stressors related to lifting patients; Workplace violence; Slips, trips, and falls; Exposure to hazardous chemicals & drugs.

Autism spectrum disorders are among the fastest-growing developmental disability diagnosis in the US. This growing number highlights the need to learn more about the services & supports that are currently available for adults with ASD, & consider those that will be needed throughout their adult lifespan. The purpose of the study was to investigate how people with ASD are being served across states in HCBS, including service eligibility, state trends specific to autism services & lessons learned.

The Lifespan Respite Care Act defines respite care as “planned or emergency careprovided to a child or adult with a special need in order to provide temporary relief to the family caregiver of that child or adult.” Respite services may be provided in a variety of settings, on a temporary basis, including the family home, adult day centers, respite centers, or residential care facilities. Respite is a key component of family support & home and community-based longterm services and supports.

This resource for programs includes State Lifespan Respite Programs, that provide respite and are interested in developing & implementing participant-directed respite, especially through voucher programs. Included are: overview materials that provide content information regarding participant direction, examples from two states that currently implement participant-directed respite programs using a voucher system, important tax and financial information, & resources for additional materials.

This report presents budgeting and contractual strategies used in Arizona, Hawaii, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, Pennsylvania, Tennessee, Texas, Washington and Wisconsin. In different ways, these states have made substantial progress in transforming their LTSS systems by developing flexible accounting policies that have reduced NF utilization and captured the savings to support their HCBS programs.