Policy alerts, briefs, letters & papers

The Georgetown University Long-Term Care Financing Project has two newly-revised fact sheets National Spending on Long-Term Care, looks at total spending for nursing home and home care services nationwide, in total and by major payers. Medicaid and Long-Term Care, describes Medicaid's role in financing long-term care, with a particular focus on home and community-based services and how states' provision of these services may be affected by the policy changes in the Deficit Reduction Act of 2005.

This report describes examples of more narrowly focused state legislation that is setting the policy and infrastructure for consumer direction, expanding the direct care workforce, and supporting persons who return to the community after living in institutions. The Appendix includes the specific legislative language of selected bills covered in the report.

The US is experiencing a severe shortage of qualified direct-care workers to provide personal care services (PCS). Evidence from a number of studies reveals that wages and benefits paid to PCS workers play a fundamental role in determining the quality and quantity of workers. Read this in-depth analysis of state and local practices that reviews the pros and cons of seven strategies for enhancing PCS-worker wages and benefits for direct-care workers delivering Medicaid personal care services.

The DRA may have significant effects, given the high proportion of young children enrolled in Medicaid-28 percent of all children under age 6 in 2001-and the broad range of services covered. This report analyzes the provisions of the DRA and assesses their implications for the provision of early childhood preventive and developmental services. Changes include citizenship documentation, the use of a benchmark option, cost-sharing benefits and the financing of targeted case management.

This self-study guide is offered as an orientation manual for new transition facilitators. Materials were developed with input from Centers for Independent Living and a variety of other organizations. A facilitator is somebody who aids or assists in the transition process. The manual helps new facilitators understand and apply the principles plus resources found useful by successful transition facilitators.

States vary greatly in the proportion of Medicaid long-term care funds expended on home and community-based services. In 2005, Oregon and New Mexico spent over two-thirds of their Medicaid LTC dollars on HCBS while Washington, D.C. and Mississippi spent less than 20 percent on HCBS. To overcome the “imbalance” states, at varying rates, have been “rebalancing” the way that Medicaid LTC services are delivered and financed to allocate a higher proportion of dollars to HCBS.

As part of the 2004 Real Choice grants, New Hampshire and Wisconsin proposed to complete a feasibility study and then develop LIFE Account programs. With no federal legislation creating a savings program, grantees are restricted to modified program that works under existing law. This paper considers six options: Section 1115 Demonstrations, Waivers under Section 1915(c) & 1915(b), Section 1915(i) & 1915(j) State Plan programs, and Section 1937 Benchmark programs and suggests some next steps.

The Alabama Medicaid Agency contracted with The Lewin Group to conduct a single point of entry feasibility study. Lewin and the Alabama Medicaid Agency staffed a single point of entry work group composed of Alabama consumers and other long term care stakeholders; this work group guided the study. A literature search on SPE best practices and national initiatives was used to develop three possible models for the state, each of which presents an array of pros and cons.

This is a comprehensive report detailing the results of Maryland's 2004 and 2005 Participant Experience Survey (PES) results. The PES is a tool, developed by Medstat that measures the experiences of participants of 1915c waivers. The Maryland Department of Health and Mental Hygiene used funds from a 2001 Real Choice Systems Change Grant to survey two Maryland waivers, the Living at Home Waiver and the Older Adults Waiver.

This CMS letter provides a status update on the web-based version of the application for 1915(c) Home and Community Based waivers, the revised paper version of the waiver application (Version 3.3) and the evaluation of it, as well as the 373 S and Q.