Policy alerts, briefs, letters & papers

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.

The third paper in the series examines what contemporary social service systems can do to promote consumer-directed services. We identify different features that make a service \"self-directed,\" and we identify characteristics of successful consumer direction and self-determination. In its present form, this paper serves as foundation work for additional dialogue and will also undergo continuing development in discussions with representatives of projects and consumer leaders in states.

The second in the series, this paper identifies the features of high-quality integrated community services and the systems that support them and serves as the foundation work for additional exploration. The paper will undergo continuing development in discussions with representatives of projects and consumer leaders, will augment assessment of existing systems and planning of new or improved systems, and ideally become an even more useful tool for those involved in systems transformation.

First of Three Papers on Unlocking the Code of Effective Systems Change - This paper attempts to create an overall framework for the discussion of systems change and to give a summary of the concepts. Several specific recommendations from other successful programs and the recommendations and guidance of the colloquium participants, can be applied now by any grantee, state, or program to enhance prospects of achieving enduring change in home- and community-based services.

This report draws on interviews with Medicaid care planners for insight into the issues that arise in establishing programs to move individuals with significant long-term care needs from institutional to community settings. The five states that participated in this study—Florida, Louisiana, New Jersey, Ohio and Washington—each received federal grants for nursing home transition activities and had varied experiences.

This report draws on interviews with state Medicaid program officials for insight into the issues that arise in establishing programs to move individuals with significant long-term care needs from institutional to community settings. The five states that participated in this study—Florida, Louisiana, New Jersey, Ohio and Washington—each received federal grants for nursing home transition activities and had varied experiences.

Due to concern that wealthy elderly Americans were transferring assets to gain Medicaid coverage for nursing home care, the Deficit Reduction Act tightened Medicaid eligibility rules. About 43 percent of all nursing home residents eventually become Medicaid eligible. Over the six-year period examined, the authors estimate that, when applying the DRA asset transfer rules, federal savings to Medicaid could amount to $1.87 billion.

Beneficiary-managed individual budget model had its origins in the Cash & Counseling Demonstration. This brief describes the evolution of the model since the original demonstration and provides an overview of state activity. Although Medicaid waivers have been required for individual budget model programs to date, the Deficit Reduction Act gives the option to use this model for an expanded range of home and community based services in the Medicaid plans without having to obtain a waiver.

What are the opportunities and potential pitfalls of this new policy that makes major changes to the Medicaid program? This paper offers explanation and analysis of the changes to the long-term services policies including: Asset Transfers, Long-term care Partnership Programs, Family Opportunity Act, Money Follows the Person Demonstration, State Option to Provide HCBS Services, Cash and Counseling Option.