Medicaid Waivers

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Public Financing Of Home And Community Services For Children And Youth With Serious Emotional Disturbances: Selected State Strategies

This report describes important system-of-care principles that have shaped the services for youth with SEDs, the role of the various agencies and the financing used by many states. It identifies and critiques four financing mechanisms: HCBS waivers, the Medicaid rehabilitation option, case rates for high risk populations, and provisions in the Tax Equity and Fiscal Responsibility Act (TEFRA). The paper ends with a synthesis of research questions and implications for legislative efforts.

Short URL: http://www.advancingstates.org/node/51000

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Independence Plus: 1915c, 1115, or DRA Comparative Matrix

This table is modified from previous chart received during CMS Presentation at 2003 HCBS Waiver Conference (October 28, 2003 Milwaukee, WI) and in draft form. It compares the 1915c, 1115, or DRA for the following issues: Level of Care/ Eligibility, Combining Populations, Budget Neutrality, Reporting, Renewal, and Evaluation, Support Brokerage, Cash Allowance, Hiring Legally Responsible Individuals, Provider Agreements, Direct Payment to Providers, Payment for Services.

Short URL: http://www.advancingstates.org/node/50991

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State Medicaid Programs Offering Personal Care Services

The purpose of this study was to describe the two ways in which Medicaid offers personal care services to low-income Americans: Medicaid Title XIX Personal Care Services (PCS) optional state plan benefit; and the Medicaid 1915(c) Home and Community-Based Services (HCBS) waivers program. A summary of the findings of this study are presented here as well as the article that appeared in the Health Care Financing Review, Summer 2001.

Short URL: http://www.advancingstates.org/node/49680

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CMCS Informational Bulletin: Medicaid Administrative Funding Availability for Long Term Care Ombudsman Program Expenditures

This bulletin reviews policy when Medicaid funding is available for certain administrative costs related to activities conducted by state Long Term Care Ombudsman (LTCO) programs that benefit the state's Medicaid program. It also summarizes the basic requirements for Medicaid administrative claiming of LTCO program activities and provides a link where states and LTCO programs can find more information regarding specific program activities that may be eligible for Medicaid administrative funding.

Short URL: http://www.advancingstates.org/node/53410

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Summary of CMS Guidance on Managed Long-Term Services and Supports

This summary draws attention to some of the most important aspects of CMS’s recently released guidance for states and stakeholders on the use of managed care for long-term services and supports (MLTSS) as well as transitioning LTSS providers into managed care systems and developing MLTSS programs. CMS identified 10 important elements that should be incorporated into managed LTSS and this document can assist consumers and their representatives in understanding these elements.

Short URL: http://www.advancingstates.org/node/53409

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Dual-Eligible Beneficiaries of Medicare and Medicaid: Characteristics, Health Care Spending, and Evolving Policies

This issue brief uses the most recent comprehensive data, from 2009, to examine the characteristics and costs of dual-eligible beneficiaries. The report also examines the different payment systems that Medicare and Medicaid use to fund care for dual-eligible beneficiaries and recent efforts at the federal and state levels to integrate those payment systems and coordinate the care between both programs. Given the high cost of dual-eligibles, legislative solutions are reviewed.

Short URL: http://www.advancingstates.org/node/53408

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Behavioral Health Treatment Needs Assessment Toolkit for States

In an effort to assist state agencies in planning for the specific behavioral health needs of emerging populations in their state, this toolkit provides state and national estimates of behavioral health disorders and program utilization, as well as step-by-step instructions to generate projections of health benefits, services and providers that will need to be addressed in the future. This resource can be helpful for mental health and substance use agencies, health plans, and Medicaid agencies.

Short URL: http://www.advancingstates.org/node/53405

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Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared: States with Memoranda of Understanding Approved by CMS

This policy brief provides a comparison of CMS’ finalized memoranda of understanding with California, Illinois, Massachusetts, Ohio, and Virginia to test a capitated model and with Washington to test a managed fee-for-service (FFS) model to integrate care and align financing for dual-eligibles. These 2013 demonstrations will introduce changes in the care delivery systems and will test a new system of payments and financing arrangements among CMS, the states and providers.

Short URL: http://www.advancingstates.org/node/53397

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The Managed Fee-for-Service Option to Integrate Care for Dual-Eligibles: A Guide for State Advocates

CMS created a financial alignment demonstration to better promote coordinated care for dual-eligibles. The fee-for-service managed care model has received less attention than capitated managed care. However, this model could be useful in states or regions where traditional managed care organizations are not well established or do not function well. This brief makes some assessments of the advantages and difficulties of the model and identifies elements necessary for successful implementation.

Short URL: http://www.advancingstates.org/node/53395

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Guidance to States using 1115 Demonstrations or 1915(b) Waivers for Managed Long Term Services and Supports Programs

CMS has released two important documents that outline essential elements of MLTSS programs that are in line with current best practices. The first document summarizes these essential elements and the second provides guidance for incorporating these essential elements into MLTSS programs operating under section 1115 or 1915(b) authorities. These standards will be used when CMS reviews states’ design, implementation and operation of MLTSS programs for approval and ongoing quality assurance.

Short URL: http://www.advancingstates.org/node/53394

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