Policy alerts, briefs, letters & papers

Financing long-term care for the nearly 10 million Americans who need services and supports to assist them in life’s daily activities continues to challenge the nation. While Medicaid is the nation’s major source of financing for long-term care services, paying for over 40% of total long-term care, its role is not well understood. Misperceptions on who qualifies and what is covered are common. The Kaiser Commission on Medicaid and the Uninsured Q & A’s outlines basic information on Medicaid.

Surveying Maryland’s 3,180 dual eligibles who are enrolled in hcbs waiver programs, the author finds that the end-of-2005 transfer of prescription drug coverage from Medicaid to Medicare under the Medicare Modernization Act of 2003 could put these beneficiaries in jeopardy. The experience in MD is likely to be typical for other states. The paper recommends a number of federal policy remedies, including 90-day prescriptions, using open or shared formularies, & lengthening the enrollment period.

Self-determination is a growing force for persons with psychiatric disabilities. Advances in technology and services, the recognition that recovery is a reality, combined with the consumer movement motto, “nothing about us without us” all pave the way for persons with psychiatric disabilities to live self-determined lives. This NMHA report outlines many of the barriers to this movement and makes recommendations and next steps.

This recent Health Affairs article presents the latest program trends in the three Medicaid home and community-based services programs (waivers, home health, & state-plan personal care) and reports a national survey of cost control policies used on waiver programs in 2002. The findings show slowing annual rates of participation growth on individual programs, widespread use of cost controls on waivers including waiting lists, and the persistence of large interstate variations.

The Independence Plus Initiative was established to give states expanded opportunities within Medicaid to allow for consumer direction of long-term services and supports. The consumer direction movement continues to evolve rapidly, and this calls for federal and state resources to evaluate new and changing programs. This issue paper explores the difference between IP and Cash and Counseling, the 1115 demonstration, IP and HCBS Waivers, and outlines policy implications.

This topic paper summarizes how states can use Medicaid to pay for most institutional transition program costs on a permanent basis as a result of policy change since 2000. It also describes how states are currently using Medicaid HCBS Waivers to pay for community transition services-temporary supports people need when trying to move such as housing deposits, utility set-up fees, and furniture.

A wage pass-through is an additional allocation of funds provided through Medicaid reimbursement for the express purpose of increasing compensation for direct-care workers. Twenty-one states have implemented these programs in expectation that doing so will help address the worker shortage. The purpose of this issue brief is to: describe the structure in selected states; summarize what is known about the impact of these programs on recruitment and retention; and identify key design elements.

This issue explores the theory that improving pre-employment training and continuing education reduces turnover by giving workers the competence and confidence they need to do the job well. The brief describe federal and state pre-employment and on-the job training requirements; examine the costs involved and how to pay for it; summarizes the research on the impact of training programs on recruitment, retention, care quality; and identifies key questions in developing initiatives.

This State Policy in Practice brief is the second in a series of reports on how states are addressing laws that regulate nursing practice to be more responsive to consumers’ preferences to live in their own communities. This brief focuses on Oregon’s policies for how nurses may collaborate with consumers in managing health maintenance activities.

States face significant obstacles in diverting individuals from institutional settings. Throughout the long-term care system, there exists an institutional bias for placing people in institutional settings over HCBS settings. Most states have some form of nursing home diversion program however, these programs face several challenges. This paper outlines many of the challenges, details strategies, and offers resources.