Policy alerts, briefs, letters & papers

CMS has issued this new letter to provide guidance on the implementation of the Deficit Reduction Act. Section 6036, Improved Enforcement of Documentation Requirements, creates a new subsection 1903(x) of the Social Security Act that requires individuals claiming U.S. citizenship to provide satisfactory documentary evidence of citizenship or nationality when initially applying for Medicaid or upon a recipient’s first Medicaid redetermination on or after July 1, 2006.

One challenge many ADRCs face is how to provide services over large geographic areas with small numbers of staff. Several states have chosen to use kiosks as part of their outreach and marketing or information and referral components. This issue brief explores kiosks in use by ADRC grantees and other organizations and discusses considerations in designing accessible kiosks.

To improve long-term care quality, state and federal policymakers are experimenting with positive incentives to reward providers who can demonstrate better quality. Incentive payment systems are part of a broader trend in the health care field, referred to as “pay-for-performance” and may consist of either financial payments or non-financial recognition. This paper describes the challenges involved in designing effective quality incentive payment systems in the long-term care sector.

A new fact sheet and report analysis Medicaid spending and enrollment trends for 2000-2004. Medicaid trends are related to the state of the nation's economy; as the economy has strengthened, increases in enrollment and spending have slowed. Rising enrollment and health care inflation produced most of Medicaid's spending increases. Even with a stronger economy, however, Medicaid's enrollment pressures remain due to demographic trends and continued declines in employer-sponsored insurance.

In 2004, Congress requested that HHS conduct a study on the shortage of direct support professionals (DSPs) supporting persons with intellectual disabilities and other developmental disabilities (ID/DD). The study includes an examination of the causes associated with high vacancy and turnover rates, and an examination of the impact this shortage may be having on services for people with ID/DD. The report offers figures on projected needs and future demands of worker recruitment and retention.

In the past decade consumer-directed (CD) services have proliferated in public programs. AARP has developed a two page Fact Sheet that offers an short overview of consumer preferences, program characteristics, the role of fiscal agents, and the ways consumer direction is expanding.

A growing number of states are turning to managed long-term care in their Medicaid programs for younger adults and elderly people with disabilities, including those with Alzheimer’s disease and other forms of dementia. This issue brief describes how two states, Massachusetts and Wisconsin, have addressed the special needs of beneficiaries with dementia in the design of their programs and makes policy recommendations for states that are considering implementing or modifying programs.

Some states incorporate caregiver support services into their programs that serve older people or adults with disabilities; in other states, it is separate with distinct eligibility criteria. Because many states are increasing HCBS funding, policymakers and administrators have a strong interest in emerging trends. This report highlights three: caregiver assessment, consumer direction in family caregiver support services, and collaborations between the aging network and the health care system.

This issue brief explores the continuing evolution of the Medicaid program on several fronts. It discusses the benefits and cost-sharing flexibility that is included in the Deficit Reduction Act and examines the implications for states, beneficiaries, and providers. The paper also explores recent trends in section 1115 waiver development and considers the use of waivers as a vehicle for restructuring Medicaid financing systems and for testing completely new approaches to health care delivery.

This brief provides background information on characteristics of the MR/DD population and describes the major information and service needs of the MR/DD population and the existing supports and services system. The brief also addresses implications for grantees serving this population and provides additional resources to facilitate ADRC planning and operations.