Policy alerts, briefs, letters & papers

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.

The National Council on Disability is required by law to annually submit a report on the status of the nation in achieving policies that guarantee equal opportunity for all individuals with disabilities and empower them to achieve economic self-sufficiency, independent living, and inclusion and integration into all aspects of society. The 2009 report focuses on current quality of life indicators and emerging trends that should be factored into future policies and programs.

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.

The three-year study examined relevant policy, program design, and cultural implications that may have an impact on enabling self-directed Medicaid beneficiaries to save money without losing benefits. Using extensive stakeholder engagement, six elements were studied: savings models; costs and benefits of self-direction; Federal tax policy; state policy context; participant needs; and an implementation plan.

For many years, Section 1115 waivers have been used in the Medicaid program and the Children’s Health Insurance Program, to provide states an avenue to test and implement coverage approaches that do not meet federal program rules. While these waivers have facilitated important program evolutions over time, some have also raised issues. This brief reviews the experience of Section 1115 Medicaid and CHIP waivers and discusses issues for the Obama administration to consider for the future.

A central part of consumer direction is ability of the consumer to manage the budget and decide what to purchase. Evaluation data and anecdotes are given to show how this ability influences the outcomes of program participants.

The trends in state Medicaid HCBS programs, target groups, participants, and expenditures are summarized and policy recommendations are made. The paper shows the progress in providing Medicaid HCBS but also identifies many current problems and policies. Inequities in access to services and limited funds result in unmet needs. Cost issues have been a primary focus of policy makers and quality problems are largely not addressed.

The authors advise Congress on how to meet the growing demand for long-term care and cope with rising health care costs by supporting HCBS. The main recommendations are: promote care coordination and disease prevention; strengthen the nonprofit home health nurse workforce; and ensure the financial viability of home-based care.

This White Paper recommends minimum data sets that states should collect to help assess the magnitude of workforce issues they face and to design and evaluate policy responses. The three basic data elements include: numbers of workers (full time and part time); stability of workforce (turnover and vacancies); and average compensation (wages and benefits). The authors also offer guidance on how to implement data collection.

When states are unable to serve all those eligible for vocational rehabilitation services, they are obligated to use an “order of selection” and first serve people with the most significant disabilities. The paper informs policymakers, agencies, providers, and consumers about the frameworks used by the federal government and selected states to deal with this issue.