Medicaid Home and Community-Based Services Programs: 2012 Data Update

Executive Summary
  1. Eiken, S., Sredl, K., Burwell, B., and Saucier, P. Medicaid Expenditures for Long Term Services and Supports (LTSS) in FY 2013, at 7, Truven Health Analytics (June 2015), available at http://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/downloads/ltss-expenditures-fy2013.pdf.

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  2. Minnesota has a Section 1115 waiver that offers some fee-for-service HCBS, including Section 1915(i) and Community First Choice services.

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Introduction
  1. Eiken, S., Sredl, K., Burwell, B., and Saucier, P. Medicaid Expenditures for Long Term Services and Supports (LTSS) in FY 2013, at 7, Truven Health Analytics (June 2015), available at http://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/downloads/ltss-expenditures-fy2013.pdf.

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  2. Olmstead v. L.C., 527 U.S. 581 (1999), available at http://www.law.cornell.edu/supct/html/98-536.ZS.html. For a discussion of Olmstead’s legacy, including legal case trends and policy developments in the last five years, see Kaiser Commission on Medicaid and the Uninsured, Olmstead’s Role in Community Integration for People with Disabilities Under Medicaid:  15 Years after the Supreme Court’s Olmstead Decision (June 2014), 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/.

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  3. Eiken, S., Sredl, K., Burwell, B., and Saucier, P. Medicaid Expenditures for Long Term Services and Supports (LTSS) in FY 2013, at 5, Truven Health Analytics (June 2015), available at http://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/downloads/ltss-expenditures-fy2013.pdf.

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  4. MFP funding expires in September 2016.  For more information, see Kaiser Commission on Medicaid and the Uninsured, Money Follows the Person:  A 2015 State Survey of Transitions, Services, and Costs (Oct.  2015), available at https://www.kff.org/medicaid/report/money-follows-the-person-a-2015-state-survey-of-transitions-services-and-costs/.

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  5. BIP funding expired on September 30, 2015.  For more information, see Kaiser Commission on Medicaid and the Uninsured, Medicaid Balancing Incentive Program:  A Survey of Participating States (June 2015), available at https://www.kff.org/medicaid/report/medicaid-balancing-incentive-program-a-survey-of-participating-states/.

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Medicaid HCBS Participants and Expenditures in 2012
  1. Kaiser Commission on Medicaid and the Uninsured, Implementing the ACA: Medicaid Spending & Enrollment Growth for FY 2014 and FY 2015 at 4 (Oct. 2014), available at https://www.kff.org/medicaid/report-section/implementing-the-aca-medicaid-spending-enrollment-growth-issue-brief.

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  2. Eiken, S., Sredl, K., Burwell, B., and Saucier, P. Medicaid Expenditures for Long Term Services and Supports (LTSS) in FY 2013, at 7, Truven Health Analytics (June 2015), available at http://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/downloads/ltss-expenditures-fy2013.pdf.

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  3. For background about § 1115 waivers, see Kaiser Commission on Medicaid and the Uninsured, Five Key Questions and Answers About Section 1115 Medicaid Demonstration Waivers (June 2011), available at https://www.kff.org/health-reform/issue-brief/five-key-questions-and-answers-about-section/.

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  4. 42 U.S.C. § 1315(a).

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  5. Self-direction of personal care services is now available to states under the § 1915(j) option, which allows states to offer self-direction provided that states offer personal care services as an optional state plan benefit or through a § 1915(c) waiver.  42 U.S.C. § 1396n(j)(4)(A); 42 C.F.R. § 441.452(a).

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  6. Expenditure data from Eiken, S., Sredl, Burwell, B., and Saucier, P. Medicaid Expenditures for Long Term Services and Supports (LTSS) in FY 2013, Truven Health Analytics (June 2015), available at http://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/downloads/ltss-expenditures-fy2013.pdf; participant data from Rhode Island Executive Office of Health and Human Services, Global Waiver Quarterly Report, January – March 2013, available at http://www.eohhs.ri.gov/Portals/0/Uploads/Documents/Quarterly%20Global%20Wavier%20Report%20January%20-%20March%20%202013_1.pdf; State of Vermont Agency of Human Services, Global Commitment to Health, Quarterly Report (November 2012), available at http://dvha.vermont.gov/global-commitment-to-health/gc-ffy12-qtr-4-report.pdf. Arizona participation counts as reported by state officials to KCMU and UCSF, 2015.

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  7. Minnesota has a Section 1115 waiver that offers some fee-for-service HCBS, including Section 1915(i) and Community First Choice services.

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  8. Medicaid.gov, Waivers, available at http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Home-and-Community-Based-1915-c-Waivers.html.

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  9. For more information about Medicaid managed care, see generally Kaiser Commission on Medicaid and the Uninsured, Medicaid and Managed Care: Key Data, Trends, and Issues (Feb. 2012), available at https://www.kff.org/medicaid/issue-brief/medicaid-and-managed-care-key-data-trends/; see also Kaiser Commission on Medicaid and the Uninsured, Key Themes in Capitated Medicaid Managed Long-Term Services and Supports Waivers (Nov. 2014), available at https://www.kff.org/medicaid/issue-brief/key-themes-in-capitated-medicaid-managed-long-term-services-and-supports-waivers/. In addition, Kansas has a combination § 1115/1915(c) waiver managed LTSS; for more information, see Kansas KanCare Waiver (11-W- 00283/7)), State of Kansas “KanCare” Section 1115 Demonstration Application, August 6, 2012, accessed Sept. 10, 2015, available at http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ks/KanCare/ks-kancare-1115-demo-app-08062012.pdf.

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Conclusion
  1. U.S. Dep’t of Labor, Information on the Final Rule:  Application of the Fair Labor Standards Act to Domestic Service, available at http://www.dol.gov/whd/homecare/finalrule.htm.  While the new rules were to be effective in January, 2015, they have not yet been enforced and were challenged in litigation.  In August, 2015, the D.C. Circuit Court of Appeals upheld the regulations.  Home Care Assoc. of America v. Weil, No. 15-5018 (D.C. Cir. Aug. 21, 2015), available at http://www.dol.gov/whd/homecare/0821appealdecision.pdf.  DOL has revised its time-limited non-enforcement policy, with no actions to enforce the new rules until 30 days after the D.C. Circuit Court’s decision becomes final, and discretion in enforcement actions considering good faith efforts to comply with the new rule through December 2015.  U.S. Dep’t of Labor, We Count on Home Care, Time-Limited Non-Enforcement Policy, available at http://www.dol.gov/whd/homecare/non-enforcement_policy.htm; see also 80 Fed. Reg. 55029 (Sept. 14, 2015), available at http://www.gpo.gov/fdsys/pkg/FR-2015-09-14/pdf/2015-23092.pdf; CMS Informational Bulletin, Self-Direction Program Options for Medicaid Payments in the Implementation of the Fair Labor Standards Act Regulation Changes (July 3, 2014), available at http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-03-2014.pdf; U.S. Dep’t of Justice, Civil Rights Division and U.S. Dep’t of Health & Human Servs., Office for Civil Rights, Dear Colleague letter (Dec. 15, 2014), available at http://www.ada.gov/olmstead/documents/doj_hhs_letter.pdf.

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