Reports

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.

This analysis examines how U.S. federal laws may be affected if the U.N. Convention on the Rights of Persons with Disabilities (CRPD) is ratified by the country. The authors summarize each CRPD article along with with U.S. laws that either guarantee the same rights or contradict the convention. The authors conclude that better implementation of existing laws or congressional action would bring federal law in line with CRPD.

Centers for Independent Living (CILs) have been providing important services to individuals with disabilities since the 1970s. State Medicaid programs have contracted with CILs to provide Medicaid-funded services. This paper examines four important home and community-based services (HCBS) provided by CILs and funded by Medicaid: case management/support coordination; personal assistance services; nursing facility transition services; and equipment and home modification.

A reader can use this report to better understand proposed rule changes regarding which TCM services are eligible for federal financial participation. Various perspectives on the changes are presented. Several tables and graphs illustrate past and projected TCM expenditures. Prompted by the Americans with Disabilities Act, CMS issued the interim rule in order to limit the growth of TCM costs. Current proposed legislation would delay rule implementation until April 1, 2009.

State leaders are interested in the experience of states that developed adult foster care as part of their service array, trends in provider supply, regulations governing providers, and quality oversight practices. This report is based on the policies and practices in five states – Arizona, Maine, Oregon, Washington and Wisconsin. The states were selected based on their approach to licensing and Medicaid coverage for this residential option. The report focuses on programs for older adults.