Reports

This paper examines the extent to which states have balanced the delivery of Medicaid-funded LTC services and supports to people in their homes and in institutions. What is unique about this report is its primary focus on older people and adults with physical disabilities separate from other LTC populations, such as people with developmental disabilities. Explore what has been accomplished under current Medicaid law and review how federal policies impact the ability to balance service delivery.

This report presents the results of a survey of state developmental disabilities agency officials regarding the determination of initial eligibility/level of care and the “annual level of care” for services furnished under Medicaid waiver and ICF/MR programs. Forty-seven (92%) states provided information on state waiver eligibility criteria and practices. The report describes state level of care assessment approaches and provides legislative cites and contact information for state staff.

This quality improvement project was developed and implemented at the Visiting Nurse Service of New York. The primary purpose of the Collaborative was to enhance quality of work life for home health aides while improving outcomes for home health patients. The Final Report examines three areas: patient outcomes; patient service use; aide job perceptions & retention. The Implementation Manual emerged out of the lessons learned from an evaluation of the agency-wide spread of tools and strategies.

While some health and economic data on people with disabilities are currently available, these data have limited use in providing a comprehensive assessment of how these individuals are faring. Additionally, the lack of more useful data limits the federal government’s ability to determine how well federal programs are serving individuals with disabilities. Read about ways better coordination could help facilitate the collection of such data to inform policy decisions.

Medicaid exception trusts are generally exempt under federal law from the usual rules of counting trust income and resources. A Special Needs Trust (SNT) is a type of exception trust established by certain third parties for the benefit of a disabled individual under age 65. This report highlights examples of state laws, forms, eligibility rules, and operating practices states use to properly administer the statutory SNT provision and make recoveries.

The authors offer recommendations for providing successful career preparation support to youth with mental health needs. They studied five successful programs to identify common design features that address frequently identified challenges in transitioning to an independent adulthood. They also offer analysis of systems level factors affecting program design and sustainability, in addition to recommendations for staff and policymakers.

This paper models the effect of occupancy rates on nursing home reimbursement. It surveys nursing home methodologies generally and specifically models the rate setting systems of California, Indiana and Pennsylvania. The modeling indicates that much of “the fixed costs” would not get calculated back into the rates. The costs that do would be allocated across all resident days used in rate setting regardless of payer source, including Medicare and private pay, limiting the Medicaid impact.

This publication presents lessons from financing projection models of long-term care (LTC). It describes the methods, conclusions, strengths and weaknesses of several models. It “also explores what such models can and cannot tell us, what research is needed to get better projections, and the key issues that must be addressed by any proposal to deliver and finance care for the baby boomer resident of the future.” This book can be ordered in hard copy or as a pdf via the links.

Here, consumers and advocates can find information and tools needed for effective self-directed mental health care. The guide summarizes the goals of self-directed planning and the rights of the consumers. It also lists strategies by states to support these services. Fact sheets and questions-and-answers provide further information on financing, eligibility, evaluation, planning, and support brokerage.

This issue brief and background paper outline the ongoing history, services, and expenditures associated with the Older Americans Act (OAA). The report also summarizes services that are funded through the OAA and other federal and state funds and are provided by the state and local agencies that comprise the Aging Services Network. Finally, key challenges to meeting the needs of the changing population are identified, especially with regards to service improvement and funding.