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  • Long-term Services and Supports: A Rebalancing Act

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    The ongoing debate over the federal budget and deficit reduction presents a balancing act for policymakers, as many compelling interests compete for scarce dollars. But for 10 million older adults and people with disabilities who need long-term services and supports, there is a "rebalancing act" in progress. The aim is to serve more people at home and in the community, and fewer people in institutions. Are there sufficient home- and community-based programs in all states…

  • State Options That Expand Access to Medicaid Home and Community-Based Services

    Report

    This background paper examines various aspects of the Medicaid program that can expand access to home and community-based services (HCBS) and rebalance long-term care spending in favor of HCBS. As a result of the long-standing requirement that states cover facility-based care, the majority of Medicaid long-term care (LTC) expenditures historically have been for institutional, rather than home and community-based, services. Over the past two decades, major efforts have been undertaken by states and the Centers…

  • Examining Medicaid Managed Long-Term Service and Support Programs: Key Issues To Consider

    Issue Brief

    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 shift to covering new populations and LTSS benefits through capitated payments to traditional risk-based managed care organizations (MCOs). It draws on current literature as well…

  • Medicaid’s Long-Term Care Users: Spending Patterns Across Institutional and Community-based Settings

    Issue Brief

    The nation's primary payer for long-term services and supports, Medicaid finances 43 percent of all spending on long-term care services and covers a range of services and supports, including those needed by people to live independently in the community, as well as services provided in institutions. This report provides an overview of long-term care users and their acute and long-term care service spending. The report finds that although the individuals who rely on long-term care…

  • Proposed Models to Integrate Medicare and Medicaid Benefits for Dual Eligibles: A Look at the 15 State Design Contracts Funded By CMS

    Issue Brief

    This brief summarizes 15 states' preliminary proposals to better coordinate care for people who are in both the Medicare and Medicaid programs. The design contracts, funded by the federal Center for Medicare and Medicaid Innovation (CMMI), are an outgrowth of new efforts under the health reform law to develop service delivery and payment models that integrate care for the nation’s nearly 9 million "dual eligibles," whose medical needs and health care costs typically exceed those…

  • A Primer on Dually Eligible Beneficiaries

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    The nine million dually eligible beneficiaries are generally poorer and sicker than other Medicare beneficiaries, tend to use more health care services, and thus account for a disproportionate share of Medicare and Medicaid spending. Because they often have complex medical and long-term care needs, and must navigate both Medicaid and Medicare benefits and financing, they present a special challenge for those seeking a more efficient and coordinated care delivery system. The panel will address such…

  • Medicaid Matters: Understanding Medicaid’s Role in Our Health Care System

    Fact Sheet

    This fact sheet provides key information about the Medicaid program and its role in our health care system and state economies. The nation’s public health insurance program for low-income people is counter-cyclical, expanding during the recent recession to assist millions of individuals and families affected by the loss of jobs and job-based health insurance. While the program has worked as intended, economic conditions have contributed to growing pressure on state budgets and Medicaid funding. This…

  • Money Follows the Person: A 2010 Snapshot

    Issue Brief

    Enacted into law in 2006 as part of the Deficit Reduction Act (DRA), the Money Follows the Person demonstration provides states with enhanced federal matching funds for twelve months for each Medicaid beneficiary transitioned from an institutional setting to a community-based setting. In July 2010, the Kaiser Commission on Medicaid and the Uninsured (KCMU) surveyed states about the current status of their MFP program including trends in enrollment, services and per capita spending.

  • A Challenge for States: Assuring Timely Access to Optimal Long-Term Services and Supports in the Community

    Issue Brief

    The Medicaid program is a major payer for long-term services and supports (LTSS) in the United States, accounting for 40 percent of total spending for long-term services and supports. The federal government has played an active role in sponsoring initiatives to promote a shift to community-based care; and evidence from several states suggests that providing care in the community can be less expensive than providing institutional care. The Affordable Care Act (ACA) provides incentives for…

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

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    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 panel and remarks on long-term services and supports by U.S. Secretary of Health and Human Services Kathleen Sebelius. The reports include: Medicaid Home and Community-Based…