Reports

The three-year study examined relevant policy, program design, and cultural implications that may have an impact on enabling self-directed Medicaid beneficiaries to save money without losing benefits. Using extensive stakeholder engagement, six elements were studied: savings models; costs and benefits of self-direction; Federal tax policy; state policy context; participant needs; and an implementation plan.

Program history, outcomes and recommendation of areas for future study are summarized. The study was commissioned to compare participant demographics to another IL program; measure cost of services and administration and see what participants purchased; gauge satisfaction and unmet needs; and understand disenrollment rates and reasons.

Here is the strategic plan guiding a statewide public-private partnership meant to improve employment opportunities for people with disabilities. The document reviews the current state of employment, the planning process, mission, priorities, and implementation and evaluation plans.

As part of this Act, requirements were instituted involving the state's ADRCs and the global budgeting process used to support them. The Act provides specific directives that address financing and management plans, implementation and operation of the Medicaid LTC expenditure reforms, and requires an annual report, one of which is also included here, that documents reallocation of funds to home and community based care.

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.