Key Issues in State Implementation of the New and Expanded Home and Community-Based Services Options Available Under the Affordable Care Act

Issue Brief

1. Kaiser Commission on Medicaid and the Uninsured, How is the Affordable Care Act Leading to Changes in Medicaid Long-Term Services and Supports (LTSS) Today?  State Adoption of Six LTSS Options (April 2013), available at http://www.kff.org/medicaid/issue-brief/how-is-the-affordable-care-act-leading-to-changes-in-medicaid-long-term-services-and-supports-ltss-today-state-adoption-of-six-ltss-options/.  BIP is only available to states that devoted less than half of their long-term care spending to HCBS in FY 2009.

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2. Kaiser Commission on Medicaid and the Uninsured, Medicaid Spending Growth Over the Last Decade and the Great Recession, 2000-2009 (February 2011), available at http://www.kff.org/medicaid/upload/8152.pdf.

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3. Distribution of Medicaid spending on long-term care, FY 2010, Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on CMS-64 data as of December 2011, available at http://www.kff.org/medicaid/state-indicator/spending-on-long-term-care-fy2010/.

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4. Kaiser Commission on Medicaid and the Uninsured, Medicaid Home and Community-Based Services Programs: 2009 Data Update (December 2012), available at http://www.kff.org/medicaid/report/medicaid-home-and-community-based-service-programs/.

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5. Id. at 6, 7.

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6. In Olmstead v. L.C., the Supreme Court held that people with disabilities have the right to live at home or in the community if they are able and do not oppose doing so, rather than to be institutionalized.  527 U.S. 581 (1999), available at http://www.law.cornell.edu/supct/html/98-536.ZS.html.

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7. For more information, see Kaiser Commission on Medicaid and the Uninsured, Medicaid Eligibility, Enrollment Simplification, and Coordination Under the Affordable Care Act:  A Summary of CMS’s March 23, 2012 Final Rule (December 2012), available at http://www.kff.org/medicaid/issue-brief/medicaid-eligibility-enrollment-simplification-and-coordination-under-the-affordable-care-act-a-summary-of-cmss-march-23-2012-final-rule/.

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8. Available at https://www.kff.org/medicaid/fact-sheet/medicaid-long-term-services-and-supports-an-overview-of-funding-authorities.

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9. For information about state waiver waiting lists, see Kaiser Commission on Medicaid and the Uninsured, Medicaid Home and Community-Based Services Programs: 2009 Data Update (December 2012), available at http://www.kff.org/medicaid/report/medicaid-home-and-community-based-service-programs/.

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10. For background, see Kaiser Commission on Medicaid and the Uninsured, Medicaid Eligibility and Enrollment for People With Disabilities Under the Affordable Care Act: The Impact of CMS’s March 23, 2012 Final Regulations (December 2012), available at: http://www.kff.org/health-reform/issue-brief/medicaid-eligibility-and-enrollment-for-people-with/.

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11. For background, see Kaiser Commission on Medicaid and the Uninsured, Medicaid Long-Term Services and Supports:  Key Considerations for Successful Transitions from Fee-For-Service to Capitated Managed Care Programs (April 2013), available at http://www.kff.org/medicaid/issue-brief/medicaid-long-term-services-and-supports-key-considerations-for-successful-transitions-from-fee-for-service-to-capitated-managed-care-programs/; Kaiser Commission on Medicaid and the Uninsured, People with Disabilities and Medicaid Managed Care: Key Issues to Consider (February 2012), available at http://www.kff.org/medicaid/issue-brief/people-with-disabilities-and-medicaid-managed-care/; Kaiser Commission on Medicaid and the Uninsured, Examining Medicaid Managed Long-Term Service and Support Programs: Key Issues to Consider (October 2011), available at http://www.kff.org/medicaid/issue-brief/examining-medicaid-managed-long-term-service-and/.

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12. States’ regular federal matching rates range from 50% to over 73% in FY 2013, depending upon a state’s per capita personal income relative to the national average. Kaiser Commission on Medicaid and the Uninsured, Medicaid: A Primer: Key Information on the Nation’s Health Coverage Program for Low-Income People (March 2013), available at http://www.kff.org/medicaid/issue-brief/medicaid-a-primer;  see generally Kaiser Commission on Medicaid and the Uninsured, Medicaid Financing: An Overview of the Federal Medicaid Matching Rate (FMAP) (September 2012), available at https://www.kff.org/health-reform/issue-brief/medicaid-financing-an-overview-of-the-federal/.

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13. Dep’t of Health & Human Servs., Amended Announcement, Planning and Demonstration Grant for Testing Experience and Functional Tools in Community-Based Long Term Services and Supports (June 27, 2013), available at https://www.grantsolutions.gov/gs/preaward/previewPublicAnnouncement.do?id=15699.

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