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This issue brief details the various eligibility pathways by which individuals with disabilities and the elderly can qualify for Medicaid coverage. The program, which serves as a safety net for many of the nation’s poorest and sickest individuals, provides health coverage to nearly 60 million Americans, including 8.5 million with disabilities and 8.
This issue brief describes the role that Medicaid plays for children with special health care needs. It explains common eligibility pathways, covered services, and program spending for these children. The Appendix includes 50-state data on the number of children with special health care needs covered by Medicaid/CHIP. A companion brief compares key characteristics of Medicaid/CHIP children with special health care needs to those covered by private insurance.
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.
In September 2023, the National Institutes of Health designated people with disabilities as a population experiencing health disparities, which will help ensure that people with disabilities are represented in research funded by the National Institutes. Also in September of 2023, the Biden Administration proposed a new rule that would update the requirements for nondiscrimination on the basis of disability. Among other changes, the proposed rule would codify the Olmstead court decision, which requires people with disabilities to be served in the most integrated setting that is appropriate. The new designation and proposed rule may reflect, in part, an increased awareness of the challenges and health disparities faced by people with disabilities, many of which were exacerbated by the COVID-19 pandemic and its aftermath.
In this analysis, KFF examines the characteristics of people with disabilities who are living in the community from the American Community Survey.
In a new analysis of survey data from state Medicaid home care programs, KFF found that in most years since 2016, there have been nearly 700,000 people on waiting or interest lists for expanded home and community-based services (HCBS), with a total of 692,000 across 38 states in 2023 and waiting lists averaging three years.
In January 2014, the Centers for Medicare and Medicaid Services (CMS) published a final rule that created new requirements for Medicaid home- and community-based services (HCBS) programs. This issue brief describes the settings rule, implementation of the rule across states and HCBS waivers, and what to watch as implementation continues.
More than half of all Medicaid beneficiaries now receive their services in risk-based managed care plans, and states’ use of managed care is expanding. States operate their own Medicaid managed care programs within federal rules and requirements. The federal regulations were last updated in 2002 and a new proposed rule is expected in Spring 2015. This brief identifies key issues in the regulation and discusses how CMS might address them.
The average person with traditional Medicare coverage paid $5,460 out of their own pocket for health care in 2016, according to a new KFF analysis and interactive tool. This $5,460 includes about $1,000 in out-of-pocket spending for long-term care facility services, averaged across all traditional Medicare beneficiaries.
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.
Long term care facility costs are the largest share of annual out of pocket spending by Medicare beneficiaries — representing 32% of their spending on services annually.
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