Reports

Over the last eight years, federal, state, and local governments have re-envisioned how to deliver and pay for an ever-growing caseload of elderly individuals and persons with disabilities who need services at home, in the workplace, or in more costly nursing facilities. This discussion provides a vision and a context for HCBS reform consistent with CMS’ vision for reforming post-acute care that focuses on addressing system barriers and informing and empowering health care consumers.

This paper explores the various participant-direction models, existing quality management strategies, and the potential for change that allows participant-directed quality management systems to remain true to the core values they were founded upon. Participant-directed programs face unique challenges in meeting federal requirements while remaining faithful to the principles of participant-direction. Well-defined roles and responsibilities are essential and will directly influence the design.

The Kaiser Commission on Medicaid and the Uninsured supported this focus group project of adults with disabilities in 4 states, who are enrolled in Medicaid Consumer Directed Personal Assistance Services programs. This research was undertaken to learn about Medicaid enrollees’ experiences in the program and their opinions about key features of the program including recruitment issues and degree of responsibility over services. Ways to improve upon the programs were also identified.

Maryland's vocational rehabilitation and mental health agencies jointly promote supported employment evidence-based practices (EBP) for people with mental illness. The state provides a payment for EBP services and monitors fidelity to EBP. Training, technical assistance, and small, time-limited grants have assisted providers transitioning to EBP. More than two-thirds of Maryland’s supported employment providers either have adopted EBP or are implementing these practices.

Consumer direction of personal assistance services (CD-PAS) is one model of service delivery that gives Medicaid beneficiaries varying degrees of control over hiring, scheduling, training, and paying personal care attendants. Program administrators, experienced with the programmatic features of CD-PAS in their state, were interviewed. Eligibility criteria, participant support services, and method of financial management used by Medicaid beneficiaries to pay direct care workers are discussed.

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The New Jersey Department of Human Services created this report to design and implement services that support individuals with disabilities as they secure and sustain employment in an integrated setting. The project developed a five-year transportation plan to identify and document transportation barriers to work for people with disabilities and made recommendations related to addressing the barriers and providing enhanced transportation services in a variety of settings throughout the state.

This report by the GAO reviewed the extent to which HHS ensured that Section 1115 Waiver demonstrations will be budget neutral to the federal government and maintain Medicaid’s fiscal integrity. Specifically, the report examined the projected spending associated with two waivers granted to Florida and Vermont. Review the shortcomings in these specific approvals as well as recommendations for further congressional oversight and HHS procedural reform.

New Jersey WorkAbility was implemented in February 2001 and extends basic Medicaid coverage to working-age residents who are employed, have a permanent disability, and have income and asset levels below specified thresholds. Find an evaluation of this program, including a description of current and former enrollees, an evaluation of the program focused on employment variables, earning trends and more, and a series of recommendations for the future.

This report gathers information on Regional Council Membership. The term Quality Councils refer to stakeholders (including representatives from the state agency, family members, providers, and consumers) who convene to address improvement in the quality of services delivered to individuals with developmental disabilities and their families. Find out how information is shared between regional and statewide councils, costs associated with operating, accomplishments, constraints and cautions.