Dual Eligibles

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An Overview of Recent Section 1115 Medicaid Demonstration Waiver Activity

Section 1115 waivers provide states an avenue to test new approaches in Medicaid that differ from federal program rules. Waivers can provide states significant flexibility in how they operate programs and can have a significant impact on program financing. As such, waivers have important implications for beneficiaries, providers, and states. This brief provides an overview of Section 1115 waiver authority, the waiver approval process, and recent waiver activity and discusses the implications.

Short URL: http://www.advancingstates.org/node/53112

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Flexible Accounting for Long-Term Care Services: State Budgeting Practices that Increase Access to Home-and Community-Based Services

This report presents budgeting and contractual strategies used in Arizona, Hawaii, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, Pennsylvania, Tennessee, Texas, Washington and Wisconsin. In different ways, these states have made substantial progress in transforming their LTSS systems by developing flexible accounting policies that have reduced NF utilization and captured the savings to support their HCBS programs.

Short URL: http://www.advancingstates.org/node/53086

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Financial Alignment Models for Medicare-Medicaid Enrollees: Considerations for Reimbursement

The 9 million individuals enrolled in both Medicare and Medicaid often receive care that is fragmented, poorly coordinated, and high-cost. Integrating their care is difficult because of the challenges associated with aligning the programs' financial incentives and reimbursement processes. This brief explores considerations for establishing reimbursement rates and performance incentives for the capitated and managed fee-for-service financial models.

Short URL: http://www.advancingstates.org/node/53049

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The Center for Medicare and Medicaid Innovation: Activity on Many Fronts

In its first year of operation, the Center for Medicare and Medicaid Innovation has a long list of accomplishments, yet some observers express concern that its fast-paced approach may be overwhelming to smaller delivery systems. A status report of the Innovation Center’s activities to date is provided, including delineating the goals envisioned by Congress, detailing the new tools it was given, and emphasizing how the enhanced authority compares with CMS’ traditional demonstration programs.

Short URL: http://www.advancingstates.org/node/53043

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On the Verge: The Transformation of Long Term Services and Supports

Many states are undergoing long-term services & supports (LTSS) transformations. The lagging economy & increased demand for publicly funded LTSS are placing pressure on state policymakers to find solutions. As a result, many states either have or plan to implement Medicaid Managed LTSS, with 12 states having existing programs & another 11 with plans for implementation. Many states used the economic downturn as an opportunity to balance services from institutional to non-institutional settings.

Short URL: http://www.advancingstates.org/node/53034

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CMS Informational Bulletin: Implementation of Section 3309 of the Affordable Care Act

This bulletin provides information that CMS hopes will be helpful to States as they work to implement section 3309 of the Affordable Care Act which eliminates Part D cost-sharing for full benefit dual eligible individuals receiving home and community-based services. The effective date for Section 3309 is January 1, 2012.

Short URL: http://www.advancingstates.org/node/53031

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Communicating the Value of Integrated Care to Stakeholders

This policy brief is part of Center for Health Care Strategies’ Technical Assistance for Dual Eligible Integrated Care Demonstrations program, made possible through The SCAN Foundation and The Commonwealth Fund. Through this program, CHCS is helping demonstration states develop and implement integrated-care models for individuals eligible for both Medicare and Medicaid services.

Short URL: http://www.advancingstates.org/node/53014

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Medicaid and Medicare Resource Use for Dual Eligibles in Maryland

This presentation, delivered by Charles Milligan to the Medicaid and CHIP Payment and Access Commission (MACPAC) in Washington, D.C., addressed the issue of coordinating long-term care for persons eligible for both Medicare and Medicaid (dual eligibles). Milligan discussed Hilltop's research on Medicare/Medicaid cross-payer effects that found that Medicare and Medicaid financing do not align to promote home and community-based services.

Short URL: http://www.advancingstates.org/node/52984

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Rebalancing Long-Term Services and Supports: Progress to Date and a Research Agenda for the Future

This report, which was presented at the Long-Term Care Interest Group Colloquium at the June 2011 AcademyHealth Annual Research Meeting in Seattle, Washington, discusses progress in rebalancing Medicaid long-term services and supports (LTSS) spending, how the Affordable Care Act can support states’ continued efforts to rebalance LTSS, and opportunities for future research to support continued system transformation.

Short URL: http://www.advancingstates.org/node/52982


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