Reports

This report, which was presented at the Long-Term Care Interest Group Colloquium at the June 2011 AcademyHealth Annual Research Meeting in Seattle, Washington, discusses progress in rebalancing Medicaid long-term services and supports (LTSS) spending, how the Affordable Care Act can support states’ continued efforts to rebalance LTSS, and opportunities for future research to support continued system transformation.

This fourth and final report for the national evaluation of the FY05, 06, and 07 Real Choice Systems Change (RCSC) Grants presents findings for both FY05 and FY06 Systems Transformation (ST) grantees. The findings address how grant efforts progressed between initial and final implementation periods and whether those efforts resulted in the achievement of grant outcomes and ultimately transformation of state systems.

Shared decision-making provides an approach through which providers and consumers of health care come together as collaborators in determining the course of care. Research has shown that SDM increases consumers’ knowledge about and comfort with the health care decisions they make. By placing mental health consumers at the center of the decision-making process, SDM provides a model through which multiple calls for transformation of the mental health field might be answered.

Older Americans Adults (OAA) reauthorization presents a unique opportunity to make significant improvements to the advocacy provisions under the Act. This paper presents three dimensions and five principles that form the basis of advocacy under the OAA, and it offers seven recommendations to strengthen advocacy within the next OAA reauthorization. Virtually every program and funding stream created by the OAA requires that the entire aging network advocate on behalf of older Americans.

Most Medicaid beneficiaries are enrolled in some form of managed care. States are expected to increase their reliance on managed care to deliver services in their Medicaid programs. This 50-state survey provides a comprehensive look at state Medicaid managed care programs, documenting their diversity, examining how states monitor access and quality, and exploring emerging efforts to improve care, including managed long-term care and initiatives targeted toward dual eligibles.

Certain states significantly outperform others in the delivery of long-term services and supports (LTSS) to older adults and people with disabilities. The report examines four key dimensions of state LTSS system performance: affordability and access; choice of setting and provider; quality of life and quality of care; support for family caregivers. It assesses each state's performance overall as well as on 25 indicators, some of which measured for the first time. Compare data on the website.

A review of the federal financing mechanisms used by state agencies to implement the evidence-based employment models ( IPS and CE) come with the recognition that the federal financing of employment services for people with serious mental illness is a shared responsibility across multiple federal agencies. Improvements in this shared responsibility can lead to more effective support for these evidence-based employment models at the state and local levels.

Summary presents key findings from a collection of nine studies conducted in 2009–2010, focusing on the employment efforts of working-age (age 18 to full retirement). Three of these reports concern TTW participants and program issues, while the other 6 are studies on more general topics related to beneficiary employment and SSA work supports. These nine studies constitute the fifth report of the Ticket to Work program evaluation.

Report illustrates the need for careful planning on how to address the health disparities experienced by persons with disabilities into the next decade. Because the perception that disability is solely an aging phenomenon, current analysis to people of working age (18-64) is limited. Also, little research compares the health disabilities to that of other racial and ethnic minority groups. The report suggests the time is now for a national plan to address disparities.

The Affordable Care Act of 2010 offers a number of options and financial incentives for states seeking to expand their systems of long-term services and supports. Many of these opportunities can be leveraged to work together and to build on existing initiatives. Key provisions of the ACA are summarized, followed by considerations for states seeking to take advantage of these new opportunities.