Long-Term Care

This brief examines Medicaid’s medically needy program, which gives states the option to extend Medicaid eligibility to those with high medical expenses whose income exceeds the maximum threshold, but who would otherwise qualify. It provides updated enrollment and spending figures on the medically needy using data through federal fiscal year…

As many states expand their use of managed care in Medicaid, a growing number of beneficiaries with disabilities are being enrolled in risk-based managed care arrangements for at least some of their care. Further growth in managed care is expected in 2014, when the Affordable Care Act expands Medicaid eligibility…

There is increased interest among states in operating Medicaid managed long-term services and support (MLTSS) programs rather than paying for long-term services and supports (LTSS) on a fee-for-service basis, as has been the general practice. This issue brief examines key issues for states to consider if they are contemplating a…

This brief summarizes lessons in offering more home and community-based services from states at the forefront of the effort. It describes current options for state Medicaid programs and draws on interviews with state officials to provide details about specific policies and procedures in states. Brief (.pdf)

These briefs examine current issues in providing more people who need long-term care services and supports access to these Medicaid services in home and community-based settings rather than in institutional ones. The first brief, Advancing Access to Medicaid Home and Community-Based Services: Key Issues Based on a Working Group Discussion…

With a shift towards providing long-term services and supports in the community, policy interest in Medicaid consumer direction of personal assistance services (CD-PAS) has grown. Although overall enrollment in these programs is small, 42 states offered consumer direction in Medicaid in 2006. These programs allow Medicaid beneficiaries control over hiring,…

The proportion of elderly adults over age 65 in nursing homes has declined over the past two decades, most noticeably in recent years. Reasons suggested for this trend include reductions in disability rates among elderly people, improvements in mechanisms for coping with disability, and changes in the residential and long-term…

Developing home and community-based service (HCBS) alternatives to institutional care has been a priority for many state Medicaid programs over the last two decades and the focus of Medicaid policy debates recently. While the majority of Medicaid long-term care dollars go toward institutional care, the national percentage of Medicaid spending…

This report illustrates through case examples the experiences and challenges of low- and modest-income people who rely on Medicaid to pay for nursing home expenses. These case examples were developed through in-person interviews with nursing home residents and their families in three states: Georgia, Kansas and Virginia. The first section…

The Deficit Reduction Act of 2005 (DRA) was signed by the President in February 2006 and included major changes to the Medicaid program. This brief provides an overview of the changes to the rules and direction of Medicaid long-term care services as enacted in the DRA.Issue Brief (.pdf)