Policy alerts, briefs, letters & papers

This is the eighth consecutive year that state Medicaid officials were surveyed to track program trends. In addition to data on expenditures and enrollment, the report outlines policy enhancements and restrictions in all states and the District of Columbia. The resource ends with a discussion of current key Medicaid issues and perspectives of State Medicaid Directors.

Determining how to optimally balance our demand for the best health care with limited funding represents one of the most challenging policy dilemmas facing the U.S. To help understand how to best accomplish this task, the document authors forecast Medicaid expenditures and enrollment for the next ten years. The data are organized by enrollment groups and service settings/categories.

The Medicaid Buy-In (MBI), Social Security Disability Income (SSDI), and Supplemental Security Income (SSI) programs all provide workers with disabilities options to maintain health coverage if they earn too much for Medicaid or Medicare benefits. The first issue brief explains how these programs compare and interact in terms of eligibility, coverage, populations, and enrollment. The second examines how MBI participants that collect SSDI utilize SSDI work incentives.

Answering the question posed in the title is one key to evaluating Medicaid Buy-In (MBI) programs. This issue brief, the fifth in a series on workers with disabilities, compares demographics, health status, and expenditures between these groups. Significant areas of difference that were identified are race, gender, diagnoses, and expenditures.

This brief, the third and final in a series, offers information on how services and supports delivered by peer providers could be financed through state and federal programs. Review approaches to different financing strategies for services rendered by Consumer Operated Service Programs (COSPs) and peer providers in traditional mental health agencies. Also included are procedure codes commonly used to bill and two federal funding streams currently for financing and provides examples from states.

This second brief, which is part 2 of a 3 part series, provides information on approaches policymakers may consider as they establish and support peer providers in traditional mental health provider agencies and networks. It discusses approaches to introducing the concept of peer providers to agencies, strategies for addressing staff attitudes regarding peer providers, supervising peer providers, liability and risk management, and other pressing issues for agencies that employ peer providers.

This first brief, which is part 1 of a 3 part series, aims to provide information to state policymakers on the two prominent models of peer support services (COSPs and peer providers). The brief discusses each model, provides examples of programs for each model, and offers a discussion of how policymakers might assess which model is right for their jurisdiction. In addition the document sets forth key questions for policymakers who are interested in developing and supporting these models.

Federal data is used to describe the status of Americans with disabilities and their quality of life. The report measures indicators such as employment, education, health status and health care, financial security, leisure and recreation, personal relationships, and crime and safety. The authors also lay out a road map for the federal government to expand the national disability indicator set, as well as for installing the set into a key national indicator system.

A final rule that would allow more Medicaid beneficiaries to be in charge of their own personal assistance services, including personal care services, instead of having those services directed by an agency, was published in the Oct 3, 2008 Federal Register. The rule, effective Nov. 3, 2008, guides states that wish to allow beneficiaries who need help with activities of daily living to hire, direct, train or fire their own personal care, workers including qualified family members.

Direct care worker (DCW) training and education are challenging issues in all states. Iowa set up a taskforce to review existing requirements, streamline the process of training and education, and to establish a DCW registry by expanding the Iowa Nurse Aide Registry. The taskforce recommends classifying DCWs by function (rather than setting or population served) and developing a governing body, a single approved curriculum, and a certification system for all DCWs.