Serving Low-Income Seniors Where They Live: Medicaid's Role in Providing Community-Based Long-Term Services and Supports
Issue Brief
See generally Victoria Peebles and Alex Bohl, CMS/Mathematica Policy Research, The HCBS Taxonomy: A New Language for Classifying Home and Community-Based Services (Aug. 2013), available at http://www.mathematica-mpr.com/~/media/publications/PDFs/health/max_ib19.pdf.
MaryBeth Musumeci and Henry Claypool, Olmstead’s Role in Community Integration for People with Disabilities Under Medicaid: 15 Years After the Supreme Court’s Olmstead Decision (June 2014) Washington, DC: Kaiser Family Foundation, available at https://www.kff.org/medicaid/issue-brief/olmsteads-role-in-community-integration-for-people-with-disabilities-under-medicaid-15-years-after-the-supreme-courts-olmstead-decision/.
Erica Reaves and MaryBeth Musumeci, Medicaid and Long-Term Services and Supports: A Primer (May 2015), available at https://www.kff.org/medicaid/report/medicaid-and-long-term-services-and-supports-a-primer/.
Terence Ng, Charlene Harrington, MaryBeth Musumeci, and Erica L. Reaves. Medicaid Home and Community-Based Services Programs: 2011 Data Update. (December 2014). Washington, DC: Kaiser Family Foundation, available at: https://www.kff.org/medicaid/report/medicaid-home-and-community-based-services-programs-2011-data-update/.
The analysis includes seniors living in a private residence, assisted living facility, or retirement community and excludes those in nursing facilities. For Medicaid funding purposes, states are currently in the process of determining whether specific settings qualify as “home and community-based” to come into compliance with recent federal regulations. 79 Fed. Reg. 2948-3039 (Jan. 16, 2014), available at http://www.gpo.gov/fdsys/pkg/FR-2014-01-16/pdf/2014-00487.pdf.
Chronic illnesses included in this analysis are arthritis, cancer, diabetes, heart disease, high blood pressure, lung disease, osteoporosis, and stroke.
Centers for Disease Control and Prevention. Older Adult Falls: Get the Facts, available at http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html.
Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj Prev. 2006 Oct;12(5):290-5.
Shumway-Cook A, Ciol MA, Hoffman J, Dudgeon BJ, Yorkston K, Chan L. Falls in the Medicare population: incidence, associated factors, and impact on health care. Phys Ther. 2009 Apr;89(4):324-32.
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.
80 Fed. Reg. 42168-42269 (July 16, 2015), available at https://www.federalregister.gov/articles/2015/07/16/2015-17207/medicare-and-medicaid-programs-reform-of-requirements-for-long-term-care-facilities.
Georgia Burke and Gwen Orlowski, Justice in Aging, Training to Serve People with Dementia: Is our Health Care System Ready?, Paper 1: Issue Overview (Aug. 2015), available at http://www.justiceinaging.org/our-work/healthcare/dementia-training-requirements/dementia-training-requirements-state-by-state/ (finding that dementia training requirements for home health aides and personal care assistants subject to state licensure exist in a minority of states and are limited in scope).
Braveman, P. et al. Housing and Health: Issue Brief #7 in Exploring the Social Determinants of Health. Robert Wood Johnson Foundation, May 2011, available at: http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf70451.
Musumeci M. Financial and Administrative Alignment Demonstrations for Dual Eligible Beneficiaries: States with Memoranda of Understanding Approved by CMS (Sept. 2015) Washington, DC: Kaiser Family Foundation, available at https://www.kff.org/medicaid/issue-brief/financial-alignment-demonstrations-for-dual-eligible-beneficiaries-compared/; Musumeci M. Key Themes in Capitated Medicaid Managed Long-Term Services and Supports Waivers. (Washington, DC: Kaiser Family Foundation), November 2014, available at: https://www.kff.org/report-section/key-themes-in-capitated-medicaid-mltss-key-themes/.
Musumeci M. Rebalancing in Capitated Medicaid Managed Long-Term Services and Supports Programs: Key Issues from a Roundtable Discussion on Measuring Performance. (Washington, DC: Kaiser Family Foundation), February 2015, available at: https://www.kff.org/medicaid/issue-brief/rebalancing-in-capitated-medicaid-managed-long-term-services-and-supports-programs-key-issues-from-a-roundtable-discussion-on-measuring-performance/; Musumeci M. Financial Alignment Demonstrations for Dual Eligible Beneficiaries: A Look at CMS’s Evaluation Plan (July 2014), available at https://www.kff.org/medicaid/issue-brief/financial-alignment-demonstrations-for-dual-eligible-beneficiaries-a-look-at-cmss-evaluation-plan/.
The Balancing Incentive Program, which provides enhanced federal funding to help states increase the proportion of LTSS dollars devoted to community-based services instead of institutional care, expires in September 2015, and the Money Follows the Person program, which provides enhanced federal funding to support institutional to community transitions, expires in September 2016. Molly O’Malley Watts et al. Medicaid Balancing Incentive Program: A Survey of Participating States (June 2015) Washington, DC: Kaiser Family Foundation, available at https://www.kff.org/medicaid/report/medicaid-balancing-incentive-program-a-survey-of-participating-states/; Molly O’Malley Watts, et al. Money Follows the Person: A 2013 State Survey of Transitions, Services and Costs (April 2014), Washington, DC: Kaiser Family Foundation, available at https://www.kff.org/medicaid/report/money-follows-the-person-a-2013-survey-of-transitions-services-and-costs/.
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/. Kaiser Family Foundation State Health Facts, Health Home State Plan Option, available at https://www.kff.org/medicaid/state-indicator/health-home-state-plan-option/.
Kaiser Family Foundation, Section 1915(k) Community First Choice State Plan Option, available at https://www.kff.org/medicaid/state-indicator/section-1915k-community-first-choice-state-plan-option/.
Kaiser Family Foundation State Health Facts, Health Home State Plan Option, available at https://www.kff.org/medicaid/state-indicator/health-home-state-plan-option/.
CMS, Providing Long Term Services and Supports in a Managed Care Delivery System, Enrollment Authorities and Rate Setting Techniques: Strategies States May Employ to Offer Managed HCBS, CMS Review Processes and Quality Requirements (Dec. 2009), available at http://www.pasrrassist.org/sites/default/files/attachments/10-07-23/ManagedLTSS.pdf.
Section 1915(i) allows states to offer the same categories of home and community-based services under their Medicaid state plans as are available under waivers. States may target services to specific populations. Section 1915(i) services must be provided statewide and waiting lists are not permitted, although states can further restrict functional eligibility criteria for future beneficiaries if the state exceeds its projected number of beneficiaries served under this option. 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/. Kaiser Family Foundation State Health Facts, Health Home State Plan Option, available at https://www.kff.org/medicaid/state-indicator/health-home-state-plan-option/.
Kaiser Family Foundation State Health Facts, Section 1915(i) Home and Community-Based Services State Plan Option, available at https://www.kff.org/medicaid/state-indicator/section-1915i-home-and-community-based-services-state-plan-option/.
Terence Ng et al. Medicaid Home and Community-Based Services Programs: 2011 Data Update (Dec. 2014), Washington, DC: Kaiser Family Foundation, available at https://www.kff.org/report-section/medicaid-home-and-community-based-services-programs-2011-data-update-eligibility-and-cost-containment-policies-used-in-medicaid-hcbs-programs/.
Ibid., at Table 14.
