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Long-Term Care: Understanding Medicaid’s Role for the Elderly and Disabled This updated report provides a review of how Medicaid works for people with long-term care needs and describes the fiscal challenges that states currently face and that Medicaid may face in the future as the population ages. Report (.pdf) Executive Summary (.pdf)
With short and long-term policy changes to the Medicaid program being discussed, its role in providing long-term care is receiving closer examination. Medicaid is the single largest source of financing for long-term care, accounting for nearly half of all the nation’s spending for long-term care services, and demographic trends are likely to place additional pressure on Medicaid. New attention is being focused on who relies on Medicaid for help with nursing home bills and how…
This issue brief describes Medicare drug benefit policy issues for residents of nursing homes and other long-term care settings, such as assisted living facilities and board and care facilities. The brief addresses differing rules for nursing home and non-nursing home settings, as well as for dual eligibles residing in long-term care facilities. Issue Brief (.pdf)
Dual eligible beneficiaries who participate in Medicaid home and community-based waiver programs usually do not have a centralized care provider to manage their health care benefits and services. For the new Medicare prescription drug benefit, no individual is designated to assist participants with their prescription drug plan selection, comparison of formularies, and if necessary, management of their exceptions and appeals should a medication be denied by their plan. This paper offers state and federal policymakers…
In recent years states have been trying to shift resources from institutional to home and community based long-term care services. This report examines "transition" and "diversion" policies and practices in eight states. It provides a sense of what state Medicaid programs are doing or could be doing to promote diversion. Report (.pdf) Executive Summary (.pdf)
This report analyzes survey data to describe the characteristics of two groups of nursing home residents who are 65 years or older: those who are discharged back to the community over a one year time period and those who remain in nursing homes for 90 days or longer. Over the last several years, some states have turned their attention to returning nursing home residents to community settings through nursing home transition programs. The findings provide…
Over the last four years, the Commission has been tracking the national development of the three main Medicaid HCBS programs that states can operate. The Commission also began to survey the policies, such as eligibility criteria and waiting lists that states can use to control the growth of spending on the waiver programs. This brief presents the latest data on the development of home and community-based service programs in Medicaid. Issue Paper (.pdf)
Individuals cannot qualify for Medicaid nursing home care or home and community-based services unless they meet their state's asset eligibility standards. Currently, states are required to examine all transfers for less than fair market value that occurred within 36 months prior to an individual's application for Medicaid. This issue paper examines the assets of elderly people living in the community, focusing on those most at risk of using nursing home care. The paper finds that…
Medicaid and Long-Term Care While Medicaid is the nation’s major source of financing for long-term care services, paying for over 40% of total long-term care, its role is not well understood. Misperceptions on who qualifies and what is covered are common. A fact sheet and a Q & A sheet about Medicaid’s role in long-term care assistance provide basic information on the topic. Medicaid’s Role in Long-Term Care: Q & A Medicaid and Long-Term Care…
Financing long-term care for the nearly 10 million Americans who need services and support to assist them in life’s daily activities continues to challenge the nation. While Medicaid is the nation’s major source of financing for long-term care services, paying for over 40% of total long-term care, its role is not well understood. Misperceptions on who qualifies and what is covered are common. A new question and answer fact sheet about Medicaid’s long-term care assistance…
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