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  • Nursing Home Care Quality:  Twenty Years After the Omnibus Budget Reconciliation Act of 1987

    Report

    Nursing Home Care Quality: Twenty Years After the Omnibus Budget Reconciliation Act of 1987 To mark the 20th anniversary of the passage of landmark federal legislation to improve the quality of nursing home care, the Omnibus Budget Reconciliation Act of 1987 (known as OBRA '87), this report explains the key provisions of OBRA ’87 related to nursing home care and examines the progress and problems in quality assurance in nursing homes over the past twenty…

  • Long-Term Service and Supports: The Future Role and Challenges for Medicaid

    Report

    This report examines the structure and impact of Medicaid’s role in long-term care. Based on a roundtable discussion of policy makers and experts and drawn from a body of health services research, the report highlights policy challenges facing the Medicaid program today and identifies issues in providing long-term care going forward. By gathering evidence to address key policy issues, such as integrating services, benefit design, quality monitoring and financing, the report can serve as a…

  • Learning From History: Deinstitutionalization of People with Mental Illness As Precursor to Long-Term Care Reform

    Report

    This report examines what policy lessons can be learned from the deinstitutionalization of people with mental illnesses and applied to potential long-term care reform for the elderly or those with significant disabilities. The study assesses the reforms that took place under deinstitutionalization, their impact and what mistakes were made. It also discusses the take-away lessons for long-term care policy, with a focus on planning, financing, living situations and the role of families, workplace issues, and…

  • Medicaid’s Rehabilitation Services Option:  Overview and Current Policy Issues

    Issue Brief

    Medicaid’s Rehabilitation Services Option: Overview and Current Policy Issues In 2007, the President reintroduced a plan to place new restrictions on the types of services allowable under the Medicaid rehabilitation services option (called the rehab option) to yield federal budget savings of $2.29 billion over the next five years. Currently, 47 states plus the District of Columbia provide at least some type of mental health, substance abuse, and physical health services under the rehab option.…

  • Changes in Characteristics, Needs, and Payment for Care of Elderly Nursing Home Residents: 1999 to 2004

    Report

    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 care options available to elderly people with disabilities. This report focuses on the characteristics, needs, and payment sources for the care of elderly nursing home…

  • Beyond Cash and Counseling: The Second Generation of Individual Budget-Based Community Long-Term Care Programs for the Elderly

    Report

    States are increasingly interested in the individual budget model for older Medicaid beneficiaries as a mechanism to improve responsiveness of benefits to beneficiaries’ needs and preferences and to increase their ability to remain outside or leave nursing homes. Beginning in January 2007, a new provision in the Deficit Reduction Act of 2005 (DRA) allows states to offer an individual budget option for an expanded range of home- and community-based services in their Medicaid state plans…

  • Medicaid and Long-Term Care: Recent Publications Illuminate Key Policy Issues

    Fact Sheet

    With recent policy debates about the future of Medicaid, the Foundation's Kaiser Commission on Medicaid and the Uninsured has created a resource page of recent publications that address key policy issues when examining Medicaid's role for high cost populations and in long-term care. Of particular interest are a report profiling six Medicaid populations with serious health needs resulting in high costs for the program and a recent analysis showing more than half (52%) of Medicaid…

  • Profiles of Medicaid’s High Cost Populations

    Issue Brief

    This paper examines the role that Medicaid plays in addressing six populations (preterm birth babies, foster care children, individuals with spinal cord and traumatic brain injuries, individuals with mental illness, individuals with intellectual and developmental disabilities, and people with Alzheimer's disease) with serious health needs resulting in high costs. For each population profiled, the report describes the condition and the need for services and supports, as well as the role of Medicaid in meeting those…

  • Medicaid 1915(c) Home and Community-Based Service Programs: Annual Data Update

    Issue Brief

    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 on HCBS has more than doubled from 1992 to 2003. This report presents a summary of the main trends to emerge from the data for…

  • Profiles of Nursing Home Residents on Medicaid

    Report

    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 of the report summarizes the themes and issues shared across the interviews Kaiser conducted, while the second section presents the individual stories of a subset…