Policy alerts, briefs, letters & papers

States are confronting challenging budgets along with the need to implement health reform. Many are looking to improve long-term care as a way to control costs and serve seniors and people with disabilities in settings they prefer. This newsletter describes provisions in the Affordable Care Act that assist states in expanding HCBS, the growing movement to improve facility-based care, and innovative programs in three states that seek to provide consumer-directed long-term care.

To better understand the dynamics of the workforce challenges that factor in to the implementation of health reform, an initiative was undertaken to examine the situation in five states (Connecticut, Michigan, Massachusetts, North Carolina and Washington). These states represented a range of geographic and political experiences as they continued to struggle with the lingering impacts of the recession and began preparing to implement health reform. Six key findings are summarized.

A Geriatric Care Manager can maximize independence and autonomy for care recipients while supporting families and caregivers. This resource discusses the various roles that this professional can play. A number of useful technologies are also suggested, including web-conferencing, monitoring and assistive devices. According to the author, despite the costs of these technologies, keeping older adults in their homes is still less expensive than placement in nursing homes.

There are wide variations in the incidence of disability among different groups of the population. A higher rate of disability means an increased likelihood of needing long-term services and supports. “Reducing disability among disadvantaged groups would result in more equal health outcomes and substantial savings in long-term care costs,” according to this report. Read this analysis on the trends of disability among different population groups.

Service definitions that focus on employment outcomes are an important component in communicating expectations and building system capacity to increase opportunities for people receiving HCBS services to participate in the general workforce. This document contains the State Employment Leadership Network’s recommendations to CMS on service definitions and related issues that reflect current practice in reinforcing a strong focus on integrated employment.

Implementation of ACA will raise a number of issues for working people with disabilities currently receiving Medicaid, especially regarding how the Acts’ provisions will interact with the programs that currently provide them access to care. This brief addresses challenges such as these, succinctly delineating data-supported lessons learned by the MIG grantees in their experience with the program, and future needs associated with them.

Despite the current budget climate that has dampened the pace of some rebalancing efforts, 32 states expanded Medicaid long-term services and supports in FY 2010 (primarily expanding HCBS programs) and 32 states planned expansions for FY2011. This updated fact sheet provides an overview of long-term care services, delivery of such services, and the large role Medicaid plays in financing long-term care.

Key provisions of the reform law offer a blueprint for tightly-coordinated and consumer-friendly eligibility and enrollment systems with seamless coverage as their goal. This brief summarizes key requirements that states face to construct enrollment systems that help people understand their options, use electronic data-matching and online processes, ensure that people obtain appropriate coverage, and support seamless transitions between coverage in the Exchanges.

A new policy brief examines the ramifications of extending the American Recovery and Reinvestment Act on Medicaid. Without the extension states may have to take drastic measures to balance state budgets. Proponents of the extension say it is essential to support the safety net and that it stimulates economic growth. Others argue the extension should only be approved if the additional federal spending is fully offset by federal budget cuts or increased federal revenues.

Health reform will bring important improvements in health care coverage for people with spinal cord injuries and people with disabilities in general. This brief summarizes insurance market reforms, HCBS options, mandatory health plan coverage provisions, Medicaid, Medicare, prevention and wellness, workforce issues and more.