Medicaid Waivers

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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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Money Follows the Person (MFP) Rebalancing Demonstration: A Work in Progress

Money Follows the Person (MFP) federal grants are provided to states in order to assist older adults and people with disabilities in transitioning from nursing facilities to home and community based settings. A history and current state of MFP are offered. This report provides an overview of how MFP has helped states to rebalance their LTSS programs and provides next steps and an outlook for the future of MFP or similar programs once the demonstration project’s funding has run out.

Short URL: http://www.advancingstates.org/node/53392

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At the Crossroads: Providing Long-Term Services and Supports at a Time of High Demand and Fiscal Constraint

A survey of state aging, disability and Medicaid agencies was conducted in 2012, in order to better understand challenges and concerns for funding and providing quality LTSS. Five common themes were identified in this report, including staff turnover and reductions during a sluggish recovery of state budgets. Other findings include an overall expansion of home and community-based services, LTSS transformation and reduced funding and high demand for non-Medicaid aging and disability services.

Short URL: http://www.advancingstates.org/node/53391

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Health Home Information Resource Center

The Affordable Care Act authorized the Medicaid Health Home State Plan Option, which allows states to design health homes to provide comprehensive care coordination for Medicaid beneficiaries with chronic conditions. States will receive enhanced federal funding to support the rollout of this new integrated model of care. This link directs to the Health Home Resource Center that provides technical assistance services for states as they submit their proposals for these health homes to CMS.

Short URL: http://www.advancingstates.org/node/53385

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Managed Care Technical Assistance Center

CMS will provide individualized technical assistance to the states on managed care program operations, including planning and procurement, benefit design and serving the needs of complex populations, access and quality, and the use of data for program oversight and management. The Medicaid Managed Care Technical Assistance Center is part of CMS's larger efforts to provide comprehensive information and guidance on Medicaid managed care program operations.

Short URL: http://www.advancingstates.org/node/53372

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Home and Community-Based Waivers for Respite Support

This compilation includes information about state 1915(c) Home and Community-Based Medicaid waivers, which provides the largest federal source of funding assistance for respite. New waiver tables have been added to this compendium for the following states: DC, Oregon, South Dakota, Utah, Washington, West Virginia, Wisconsin and Wyoming. Individual tables were also added to the Search Results pages for each of these states in the National Respite Locator under Respite Funding and Eligibility.

Short URL: http://www.advancingstates.org/node/53348

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