Issue Brief
  1. Charlene Harrington, Helen Carrillo, and Rachel Garfield, Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2009 Through 2014 (Washington, DC: Kaiser Commission on Medicaid and the Uninsured (KCMU), August 2015), available at https://www.kff.org/medicaid/report/nursing-facilities-staffing-residents-and-facility-deficiencies-2009-through-2014/.

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  2. KCMU analysis of 2011 National Health and Aging Trends Study (NHATS) data. NHATS estimate of dementia includes self- or proxy reported cognitive impairment that indicates probable or possible dementia. For more information on measurement of dementia in the NHATS, see Kasper, JD, Freedman VA, Spillman BC.  Classification of Persons by Dementia Status in the National Health and Aging Trends Study. Technical Paper #5. 2013, available at www.nhats.org.

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  3. Kasper, J, V. A. Freedman, B. C. Spillman, and J.L. Wolff. 2015. “The Disproportionate Impact of Dementia on Family and Unpaid Caregiving to Older Adults.” Health Affairs, 34(10): 1642-9.

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  4. Freidman, E.M., R.A. Shih, K.M. Langa, and M.D. Hurd. 2015. “US Prevalence and Predictors of Informal Caregiving for Dementia.” Health Affairs. 34(10): 1637-41.

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  5. KCMU analysis of pooled 2010-2012 Medical Expenditures Panel Survey data. Estimates of dementia based on MEPS are based on HCUP clinical classification code 653 MHSA: Delirium, dementia, and amnestic and other cognitive disorder. The clinical classification code aggregates procedures and diagnoses into clinically meaningful groups. It is based on ICD-9 codes and thus includes only people who use a health care service and had that service coded as related to dementia.

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  6. U.S. Census Bureau Population Estimates and Projections in U.S. Department of Health and Human Services, A Profile of Older Americans: 2014 (Washington, DC: Administration on Aging, Administration on Community Living, 2015), available at http://www.aoa.acl.gov/Aging_Statistics/Profile/2014/docs/2014-Profile.pdf.

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  7. KCMU analysis of pooled 2010-2012 Medical Expenditures Panel Survey data. Estimates of dementia based on MEPS are based on HCUP clinical classification code 653 MHSA: Delirium, dementia, and amnestic and other cognitive disorder. The clinical classification code aggregates procedures and diagnoses into clinically meaningful groups. It is based on ICD-9 codes and thus includes only people who use a health care service and had that service coded as related to dementia.   

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  8. Ibid.

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  9. For more information, see generally MaryBeth Musumeci, The Affordable Care Act’s Impact on Medicaid Eligibility, Enrollment, and Benefits for People with Disabilities (Washington, DC: KCMU, April 2014), available at https://www.kff.org/health-reform/issue-brief/the-affordable-care-acts-impact-on-medicaid-eligibility-enrollment-and-benefits-for-people-with-disabilities/.

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  10. See MACPAC, Report to the Congress on Medicaid and CHIP at Table 11, Medicaid Income Eligibility Levels as a Percentage of the Federal Poverty Level for Individuals Age 65 and Older and Persons with Disabilities by State, 2014, (Washington DC, March 2014), available at https://www.macpac.gov/wp-content/uploads/2015/01/2014-03-14_Macpac_Report.pdf.

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  11. States that elect the § 209(b) option are permitted to use definitions of disability or financial eligibility standards that are more restrictive than the federal SSI rules, so long as the state’s rules are not more restrictive than those in effect in January, 1972.  Section 209(b) states must allow SSI beneficiaries to establish Medicaid eligibility through a spend-down by deducting unreimbursed out-of-pocket medical expenses from their countable income.

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  12. Molly O’Malley Watts and Katherine Young, The Medicaid Medically Needy Program: Spending and Enrollment Update (Washington, DC: KCMU, December 2012), available at https://www.kff.org/medicaid/issue-brief/the-medicaid-medically-needy-program-spending-and/.

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  13. States may cover individuals with a need for institutional level care who also have incomes up to 300 percent of the SSI federal benefit rate ($26,388 per year for an individual in 2015) and, at state option, limited assets. States also may choose to provide Medicaid to people with functional needs that are less severe than those required to qualify for an institutional level of care; at state option, these groups include (1) people who are not otherwise eligible for Medicaid with income up to 150 percent of the federal poverty level ($17,655 per year for an individual in 2015) and no asset limit; and/or (2) people who would be eligible for Medicaid through an existing waiver with income below 300 percent of the SSI federal benefit rate. This last set of eligibility pathways are available through § 1915(i), which allows states to offer the same categories of home and community-based services under their Medicaid state plans as are available under waivers.  Molly O’Malley Watts et al. How is the Affordable Care Act Leading to Changes in Medicaid Long-Term Services and Supports Today?  State Adoption of Six LTSS Options (April 2013), Washington, DC: Kaiser Family Foundation, available at https://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/.

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  14. Medicaid also helps dual eligible beneficiaries with Medicare premiums and cost-sharing. For more information, see Katherine Young, Rachel Garfield, MaryBeth Musumeci, Lisa Clemans-Cope, and Emily Lawton, Medicaid’s Role for Dual Eligible Beneficiaries (Washington, DC: KCMU, August 2013), available at https://www.kff.org/medicaid/issue-brief/medicaids-role-for-dual-eligible-beneficiaries/.

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  15. For more information see Brigette Courtot, Emily Lawton, and Samantha Artiga, Medicaid Enrollment and Expenditures by Federal Core Requirements and State Options (Washington, DC: KCMU, January 2012 Update), available at https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-and-expenditures-by-federal-core/.

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  16. For more information see Molly O’Malley Watts, MaryBeth Musumeci, and Erica L. Reaves, How is the Affordable Care Act Leading to Changes in Medicaid Long-Term Services and Supports (LTSS) Today? State Adoption of Six LTSS Options (Washington, DC: KCMU, April 2013), available at https://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/; Kaiser Family Foundation State Health Facts, Section 1915(k) Community First Choice State Plan Option as of September  2015, available at https://www.kff.org/medicaid/state-indicator/section-1915k-community-first-choice-state-plan-option/.

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  17. Currently, Washington’s health home benefit is not funded to continue beyond 2015. For more information, see Washington State Health Care Authority, Health Home Termination Draft Phase-out Plan 8/20/2015, accessed August 25, 2015, http://www.hca.wa.gov/medicaid/health_homes/Documents/hhdraftphaseoutplan.pdf.

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  18. “Approved Health Home State Plan Amendments,” Medicaid.gov, accessed August 14, 2015, http://www.medicaid.gov/state-resource-center/medicaid-state-technical-assistance/health-homes-technical-assistance/approved-health-home-state-plan-amendments.html.

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  19. Terence Ng, Charlene Harrington, MaryBeth Musumeci, and Erica L. Reaves, Medicaid Home and Community-Based Services Programs: 2011 Data Update (Washington, DC: KCMU, December 2014), available at https://www.kff.org/medicaid/report/medicaid-home-and-community-based-services-programs-2011-data-update/; see also Erica L. Reaves and MaryBeth Musumeci, Medicaid Long-Term Services and Supports: A Primer (Washington, DC: KCMU, May 2015), available at https://www.kff.org/medicaid/report/medicaid-and-long-term-services-and-supports-a-primer/. States also may offer HCBS under the Section 1915(i) state plan option as an alternative to waivers. For more information see Molly O’Malley Watts, MaryBeth Musumeci, and Erica L. Reaves, How is the Affordable Care Act Leading to Changes in Medicaid Long-Term Services and Supports (LTSS) Today? State Adoption of Six LTSS Options (Washington, DC: KCMU, April 2013), available at https://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/.

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  20. Massachusetts Frail Elder Waiver (0059.R06.00), Application for a § 1915(c) Home and Community-Based Services Waiver (Jan. 1, 2014), accessed August 27, 2015, available at http://www.medicaid.gov/medicaid-chip-program-information/by-topics/waivers/waivers_faceted.html.

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  21. Virginia Alzheimer’s Assisted Living Waiver (40206.R02.00), Application for a § 1915(c) Home and Community-Based Services Waiver (July 1, 2013), accessed Sept. 8, 2015, available at http://www.medicaid.gov/medicaid-chip-program-information/by-topics/waivers/waivers_faceted.html.

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  22. Terence Ng, Charlene Harrington, MaryBeth Musumeci, and Erica L. Reaves, Medicaid Home and Community-Based Services Programs: 2011 Data Update (Washington, DC: KCMU, December 2014), available at https://www.kff.org/medicaid/report/medicaid-home-and-community-based-services-programs-2011-data-update/.

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