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Implications of the Expiration of Medicaid Long-Term Care Spousal Impoverishment Rules for Community Integration

To financially qualify for Medicaid long-term services and supports (LTSS), an individual must have a low income and limited assets. In response to concerns that these rules could leave a spouse without adequate means of support when a married individual needs LTSS, Congress created the spousal impoverishment rules in 1988. Originally, these rules required states to protect a portion of a married couple’s income and assets to provide for the “community spouse’s” living expenses when determining nursing home financial eligibility, but gave states the option to apply the rules to home and community-based services (HCBS) waivers.
Section 2404 of the Affordable Care Act (ACA) changed the spousal impoverishment rules to treat Medicaid HCBS and institutional care equally from January 2014 through December 2018. Congress subsequently extended Section 2404 through December 2019. This issue brief answers key questions about the spousal impoverishment rules, presents 50-state data from a 2018 Kaiser Family Foundation survey about state policies and future plans in this area, and considers the implications if Congress does not further extend Section 2404.

Medicaid’s Money Follows the Person Program: State Progress and Uncertainty Pending Federal Funding Reauthorization

Medicaid’s Money Follows the Person (MFP) demonstration has helped seniors and people with disabilities move from institutions to the community by providing enhanced federal matching funds to states since 2007. The program operates in 44 states and has served over 90,000 people as of June 2018. The program is credited with helping many states establish formal institution to community transition programs that did not previously exist by enabling them to develop the necessary service and provider infrastructure. With a short-term funding extension set to expire on December 31, 2019, MFP’s future remains uncertain without a longer-term reauthorization by Congress.

Getting Connected: Can the ACA Improve Access to Health Care in Rural Communities?

Residents of rural communities face unique health care challenges, including fewer health care providers, higher rates of chronic disease, and lower adoption rates of health information technology. This October 13 briefing, cosponsored by the Alliance for Health Reform and the United Health Foundation, looked at the many provisions in the…

New Resources & Briefing Examine Medicaid Long-Term Services and Supports

The following resources by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) examine the latest data findings regarding Medicaid’s long-term services and supports for seniors and people with disabilities. The materials were released at a public briefing in the Foundation’s Washington, D.C. offices that featured an expert…

Key Themes in Capitated Medicaid Managed Long-Term Services and Supports Waivers

This issue brief analyzes key themes in 19 capitated § 1115 and § 1915(b)/(c) Medicaid managed long-term services and supports (MLTSS) waivers approved to date by the Centers for Medicare and Medicaid Services (CMS) with a focus on covered populations and services, provisions aimed at expanding beneficiary access to HCBS, beneficiary protections, and quality measurement and oversight.

Faces of Dually Eligible Beneficiaries: Profiles of People with Medicare and Medicaid Coverage

This brief examines the role of Medicare and Medicaid in the lives of dually eligible beneficiaries – low-income seniors and younger adults with disabilities who are eligible for both programs – through personal profiles. It includes a glossary of eligibility and service delivery system terms and state-level enrollment and expenditure data for dual eligibles.

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

This report summarizes the key participation and spending trends in 2012 for the three main Medicaid Home and Community-Based Services (HCBS) programs – (1) the mandatory home health services state plan benefit, (2) the optional personal care services state plan benefit, and (3) optional § 1915(c) HCBS waiver services. Also highlighted are 2014 state eligibility, enrollment, and provider reimbursement policies.