Policy alerts, briefs, letters & papers

This is the first in a series of papers synthesizing the ideas and practices of states as they improve the quality of home and community based services (HCBS) and supports for older persons and persons with disabilities. Building on the experiences and challenges of the QA/QI Systems Change grantees, the paper addresses four fundamental questions about quality management. The intent is to provide an account of current practice, and a structure for how states view their options.

Gainful employment is entirely possible for people with disabilities and yet it remains outside the grasp for many who remain unemployed or grossly underemployed. Success in employment is caught in a vicious circle with the insufficiency of employment supports, health care coverage, education and training, and income potential. Further aggravating that cycle are barriers in transportation, child care, accessible and affordable housing.

This article profiles some suggests on prevention which occurs on three levels. Primary prevention targets healthy individuals and groups to stop disease before it starts; secondary prevention targets those at early stages of disease or with high risk behaviors but who are asymptomatic; and tertiary prevention targets those with symptomatic disease, to manage or improve their conditions. ADRCs can promote health by offering information assistance and resources on each of these levels.

This brief summarizes presentations made at NASHP’s 17th annual state health policy conference during a session on “Promoting Young Children’s Healthy Mental Development.” The session focused on the evidence base, state program highlights, a discussion of the ABCD program, and ways to use the Medicaid program to better support early childhood social and emotional development. Thie brief is available from the Assuring Better Child Health and Development initiative (ABCD II).

Individuals with certain combinations of needs who enroll in both the state-administered Medicaid program and the federally-administered Medicare program are referred to as dual eligibles. Currently, they receive prescription drugs and most LTC benefits from Medicaid, while they are covered by Medicare for acute benefits. Because dual eligibles receive benefits from both programs, many care coordination challenges arise in delivering high-quality, cost effective, & comprehensive benefits.

This November 2004 issue brief addresses how states can control costs of the Medicaid program, often the second largest item in state budgets, after education. Every state has taken cost containment actions, & all plan to take additional measures to constrain growth. Enrollment has increased as a result of declining household incomes and declining rates of employer-sponsored insurance. Other factors such as the aging of the population will continue to affect the whole health care system.

This November 2004 issue brief addresses the federal medical assistance percentage (FMAP). The reimbursement percent is calculated according to a formula established in the Medicaid statute & based on the per capita income in each state. The fact that the FMAP is based on historical data is sometimes of concern to states. Additionally, the current system makes no specific provision for changes in the economy, leaving states confronted with increased costs when they can least afford them.

FPECA is a type I Research Center, charged by the Florida Board of Regents to inform policymakers, media representative, scholars, and advocates on policies, programs, and services for older adults. Available on the site: Florida Training Academy on Aging, State Data Center on Aging, Task Force on the Availability and Affordability of Long-Term Care. FPECA produced reports and a periodic journal, Aging Research and Policy Report.

This brief describes currently available opportunities for consumer direction of care in public programs and private insurance plans, including opportunities for family caregivers to take on roles as representative decision-makers and paid caregivers. Includes recent findings from “Cash and Counseling” demonstrations and assesses prospects for expansion of consumer-directed alternatives to traditional modes of financing and service delivery.

Medstat identified common factors of system change in a six-page brief, based on a review of organization transformation literature and, more importantly, the experiences of eight state long-term support systems that were the subject of a series of case studies on comprehensive system reform.