Reports

This paper provides an overview of the health coverage interventions tested by CMS DSW demonstration grantees and examines four approaches in more detail through the following four case studies:(1)Subsidizing Employer Based Insurance(North Carolina),(2)Prescription Discounts, Basic Health Insurance and Tax-Free Accounts(New Mexico),(3)DirigoChoice and Outreach to Home Care Agencies(Maine)and (4)Outreach to Consumer-Directed Home Care Workers (Washington).

A central part of consumer direction is ability of the consumer to manage the budget and decide what to purchase. Evaluation data and anecdotes are given to show how this ability influences the outcomes of program participants.

The authors present evidence in support of states investing in HCBS and nursing home diversion as strategies to deal with declining revenue. They review research reports illustrating how the balance of spending on institutional versus HCBS spending affects future long-term care costs. Using these data and case studies of Washington and Vermont programs, they conclude that HCBS is indeed cost-effective.

The question posed in the title is answered by analyzing state spending data from 1995-2005. The report shows that, for two distinct populations receiving long-term care services, spending growth was greater for states offering limited noninstitutional services than for states with large, well-established noninstitutional programs. Expansion of HCBS appears to entail a short-term increase in spending, followed by a reduction in institutional spending and long-term cost savings.

The trends in state Medicaid HCBS programs, target groups, participants, and expenditures are summarized and policy recommendations are made. The paper shows the progress in providing Medicaid HCBS but also identifies many current problems and policies. Inequities in access to services and limited funds result in unmet needs. Cost issues have been a primary focus of policy makers and quality problems are largely not addressed.

Trends of population, economics, health status, health risks and behaviors and health care are drawn from several governmental statistics sources. Over 38 indicators are complemented by a one-time special feature on health literacy. This is the fourth chart book prepared since 2000. Detailed tables are available as excel spreadsheets.

This White Paper recommends minimum data sets that states should collect to help assess the magnitude of workforce issues they face and to design and evaluate policy responses. The three basic data elements include: numbers of workers (full time and part time); stability of workforce (turnover and vacancies); and average compensation (wages and benefits). The authors also offer guidance on how to implement data collection.

When states are unable to serve all those eligible for vocational rehabilitation services, they are obligated to use an “order of selection” and first serve people with the most significant disabilities. The paper informs policymakers, agencies, providers, and consumers about the frameworks used by the federal government and selected states to deal with this issue.

Learn from 10 years of experience in administering the consumer-directed Cash & Counseling program in Arkansas. The report provides a candid history of the development, implementation, and lessons learned from the program. The author gives details on partnership development and use, changes in agency culture and operations, and data on outcomes, cost neutrality, and participant demographics. Also included are the 2003 and 2008 program budgets.

The majority of NH’s long-term care (LTC) expenditures go to nursing homes, despite the fact that only 2% of surveyed AARP members prefer to receive care in that setting. The AARP surveyed 800 randomly-selected members to set their advocacy agenda in the state. Other opinions gauged deal with ability to pay for LTC, personal sources of LTC financing, volunteerism, and voting practices.