Medicaid and Long-Term Services and Supports: A Primer
Report
Assisted living facilities are another setting in which LTSS may be provided. In January 2014, Centers for Medicare and Medicaid Services (CMS) finalized new rules outlining the qualities that settings must meet to be considered “home and community-based” for the provision of Medicaid services. 79 Fed. Reg. 2948 (Jan. 16, 2014), http://www.gpo.gov/fdsys/pkg/FR-2014-01-16/pdf/2014-00487.pdf.
Olmstead v. L.C. 527 U.S. 581 (1999), http://www.law.cornell.edu/supct/html/98-536.ZS.html.
Susan C. Reinhard, Carol Levine, and Sarah Samis, Home Alone: Family Caregivers Providing Complex Chronic Care (Washington, DC: AARP Public Policy Institute, October 2012), http://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/home-alone-family-caregivers-providing-complex-chronic-care-rev-AARP-ppi-health.pdf.
“Who Needs Care?,” U.S. Department of Health and Human Services (HHS), accessed December 10, 2015, http://longtermcare.gov/the-basics/who-needs-care/.
AARP Public Policy Institute, Across the States 2012: Profiles of Long Term Services and Supports (Washington, DC: AARP Public Policy Institute, September 2012), http://www.aarp.org/content/dam/aarp/research/public_policy_institute/ltc/2012/across-the-states-2012-full-report-AARP-ppi-ltc.pdf.
“Who Needs Care?,” HHS, accessed December 10, 2015, http://longtermcare.gov/the-basics/who-needs-care/.
AARP Public Policy Institute, Across the States 2012: Profiles of Long Term Services and Supports (Washington, DC: AARP Public Policy Institute, September 2012), http://www.aarp.org/content/dam/aarp/research/public_policy_institute/ltc/2012/across-the-states-2012-full-report-AARP-ppi-ltc.pdf.
Who Needs Care?,” HHS, accessed December 10, 2015, http://longtermcare.gov/the-basics/who-needs-care/.
Genworth, Genworth 2015 Cost of Care Survey (Richmond, VA: Genworth Financial, Inc., April 2015), https://www.genworth.com/dam/Americas/US/PDFs/Consumer/corporate/130568_040115_gnw.pdf.
Id.
The "Other Public" payer category includes the Children's Health Insurance Program, the Department of Defense, the Department of Veterans Affairs, worksite health care, the Indian Health Service, workers' compensation, general assistance, maternal and child health, vocational rehabilitation, other federal programs, Substance Abuse and Mental Health Services Administration, other state and local programs, and school health.
Urban Institute estimates based on FY 2013 data from CMS Form 64, prepared for KCMU, exclude administrative spending, adjustments, and payments to the territories.
People with end-stage renal disease must have worked long enough to qualify for Medicare Part A (or be the spouse or dependent child of someone who qualifies for Part A) and be on regular dialysis or require a transplant in order to be eligible for Medicare before the age of 65. For more background see Kaiser Family Foundation, Medicare at a Glance (Washington, DC: Kaiser Family Foundation, September 2014), https://www.kff.org/medicare/fact-sheet/medicare-at-a-glance-fact-sheet/.
Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on data from FY 2011 Medicaid Statistical Information System (MSIS). 2010 MSIS data was used for Florida, Kansas, Maine, Maryland, Montana, New Mexico, New Jersey, Oklahoma, Texas, and Utah.
For more information on Medicare’s role for dual eligible beneficiaries, see Gretchen Jacobson, Tricia Neuman, and Anthony Damico, Medicare’s Role for Dual Eligible Beneficiaries (Washington, DC: Kaiser Family Foundation, April 2012), https://www.kff.org/medicare/issue-brief/medicares-role-for-dual-eligible-beneficiaries/.
For more information on Medicaid’s role for dual eligible beneficiaries, see Katherine Young, Rachel Garfield, MaryBeth Musumeci, Lisa Clemans-Cope, and Emily Lawton, Medicaid’s Role for Dual Eligible Beneficiaries (Washington, DC: KCMU, August 2013), https://www.kff.org/medicaid/issue-brief/medicaids-role-for-dual-eligible-beneficiaries/.
Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on data from FY 2010 MSIS and CMS Form 64. Because 2010 data were unavailable, 2009 MSIS data were used for CO, ID, MO, NC, and WV, and then adjusted to 2010 CMS Form 64 spending levels.
For background about the financial alignment demonstrations, see MaryBeth Musumeci, Financial and Administrative Alignment Demonstrations for Dual Eligible Beneficiaries Compared: States with Memoranda of Understanding Approved by CMS (Washington, DC: KCMU, December 2015), https://www.kff.org/medicaid/issue-brief/financial-alignment-demonstrations-for-dual-eligible-beneficiaries-compared/.
MaryBeth Musumeci, Long-Term Services and Supports in the Financial Alignment Demonstrations for Dual Eligible Beneficiaries (Washington, DC: KCMU, November 2013), https://www.kff.org/medicaid/issue-brief/long-term-services-and-supports-in-the-financial-alignment-demonstrations-for-dual-eligible-beneficiaries/.
America’s Health Insurance Plans (AHIP), Who Buys Long-Term Care Insurance in 2010–2011? A Twenty Year Study of Buyers and Non-Buyers (In the Individual Market) (Washington, DC: AHIP, March 2012), https://www.ahip.org/WhoBuysLTCInsurance2010-2011/.
For more information about the Long-Term Care Partnership Program, see U.S. Government Accountability Office, Overview of the Long-Term Care Partnership Program (GAO-05-1021) (Washington, DC: GAO, September 2005), http://www.gao.gov/new.items/d051021r.pdf.
KCMU estimates based on CMS National Health Expenditure Accounts data for 2013.
Harriet Komisar, Juliette Cubanski, Lindsey Dawson, and Tricia Neuman, Key Issues in Understanding the Economic and Health Security of Current and Future Generations of Seniors (Washington, DC: Kaiser Family Foundation, March 2012), https://www.kff.org/medicaid/issue-brief/key-issues-in-understanding-the-economic-and/.
Gretchen Jacobson, Jennifer Huang, Tricia Neuman, and Karen E. Smith, Income and Assets of Medicare Beneficiaries, 2013 – 2030, (Washington, DC: Kaiser Family Foundation, January 2014), https://www.kff.org/medicare/issue-brief/income-and-assets-of-medicare-beneficiaries-2013-2030/.
See 42 U.S.C. § 1396p(c).
“Medicaid Employment Initiatives,” CMS, accessed December 10, 2015, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Grant-Programs/Employment-Initiatives.html.
For more information, see KCMU, Medicaid Long-Term Services and Supports: An Overview of Funding Authorities (Washington, DC: KCMU, September 2013), https://www.kff.org/medicaid/fact-sheet/medicaid-long-term-services-and-supports-an-overview-of-funding-authorities/.
Urban Institute estimates based on FY 2013 CMS Form 64 data as of September 2014.
KCMU and Urban Institute estimates based on FY 2011 MSIS and CMS Form 64 data.
KCMU and Urban Institute analysis of CMS Form 64 data.
Terence Ng, Charlene Harrington, MaryBeth Musumeci, and Erica L. Reaves, Medicaid Home and Community-Based Services Programs: 2011 Data Update (Washington, DC: KCMU, December 2014), https://www.kff.org/medicaid/report/medicaid-home-and-community-based-services-programs-2011-data-update/.
For background about Section 1115 waivers, see KCMU, Five Key Questions and Answers About Section 1115 Medicaid Demonstration Waivers (Washington, DC: KCMU, June 2011), https://www.kff.org/health-reform/issue-brief/five-key-questions-and-answers-about-section/.
Self-direction of personal care services is available to states under the Section 1915(j) option, which allows states to offer self-direction provided that states offer personal care services as an optional state plan benefit or through a Section 1915(c) waiver. 42 U.S.C. § 1396n(j)(4)(A); 42 C.F.R. § 441.452(a). States also must offer beneficiaries the opportunity to self-direct services if they implement the Community First Choice option to provide attendant care services and supports.
Molly O’Malley Watts, MaryBeth Musumeci, and Erica L. Reaves, How is the Affordable Care Act Leading to Changes in Medicaid Long-Term Services and Supports (LTSS) Today? State Adoption of Six LTSS Options (Washington, DC: KCMU, April 2013), https://www.kff.org/medicaid/issue-brief/how-is-the-affordable-care-act-leading-to-changes-in-medicaid-long-term-services-and-supports-ltss-today-state-adoption-of-six-ltss-options/.
For more information, see KCMU, Medicaid Long-Term Services and Supports: An Overview of Funding Authorities (Washington, DC: KCMU, September 2013), https://www.kff.org/medicaid/fact-sheet/medicaid-long-term-services-and-supports-an-overview-of-funding-authorities/.
MaryBeth Musumeci, Erica L. Reaves, Julia Paradise, and Henry Claypool, Key Issues in State Implementation of the New and Expanded Home and Community-Based Services Options Available Under the Affordable Care Act (Washington, DC: KCMU, September 2013), https://www.kff.org/medicaid/issue-brief/key-issues-in-state-implementation-of-the-new-and-expanded-home-and-community-based-services-options-available-under-the-affordable-care-act/.
Terence Ng, Charlene Harrington, MaryBeth Musumeci, and Erica L. Reaves, Medicaid Home and Community-Based Services Programs: 2011 Data Update (Washington, DC: KCMU, December 2014), https://www.kff.org/medicaid/report/medicaid-home-and-community-based-services-programs-2011-data-update/.
MaryBeth Musumeci, Key Themes in Capitated Medicaid Managed Long-Term Services and Supports Waivers, (Washington, DC: KMCU, November 2014), https://www.kff.org/medicaid/issue-brief/key-themes-in-capitated-medicaid-managed-long-term-services-and-supports-waivers/.
MaryBeth Musumeci, Rebalancing in Capitated Medicaid Managed Long-Term Services and Supports Programs: Key Issues from a Roundtable Discussion on Measuring Performance (Washington, DC: KMCU, February 2015), https://www.kff.org/medicaid/issue-brief/rebalancing-in-capitated-medicaid-managed-long-term-services-and-supports-programs-key-issues-from-a-roundtable-discussion-on-measuring-performance/.
National Committee for Quality Assurance (NCQA), Integrated Care for People with Medicare and Medicaid: A Roadmap for Quality at 9 (Washington, DC: NCQA, March 2013), http://www.ncqa.org/portals/0/public%20policy/NCQAWhitePaper-IntegratedCareforPeoplewithMedicareandMedicaid.pdf.
Susan C. Reinhard, Enid Kassner, Ari Houser, Kathleen Ujvari, Robert Mollica, and Leslie Hendrickson, Raising Expectations, 2014: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers (Washington, DC: AARP; New York, NY: The Commonwealth Fund; and Long Beach, CA: The SCAN Foundation, June 2014), http://www.longtermscorecard.org/~/media/Microsite/Files/2014/Reinhard_LTSS_Scorecard_web_619v2.pdf.
Medicare.gov Nursing Home Compare,” CMS, accessed December 10, 2015, http://www.medicare.gov/nursinghomecompare/search.html.
Janet Wells and Charlene Harrington, Implementation of Affordable Care Act Provisions To Improve Nursing Home Transparency, Care Quality, and Abuse Prevention, (Washington, DC: KMCU, January 2013), https://www.kff.org/medicaid/report/implementation-of-affordable-care-act-provisions-to-improve-nursing-home-transparency-care-quality-and-abuse-prevention/.
For more information, see “Quality of Care Home and Community-Based Services (HCBS) Waivers,” CMS, accessed December 10, 2015, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Quality-of-Care-HCBS.html.
“Measure Applications Partnership,” National Quality Forum, accessed December 10, 2015, http://www.qualityforum.org/map/.
“Medicaid Home and Community-Based Services Measure Scan: Project Methodology,” Agency for Healthcare Research and Quality, accessed December 10, 2015, http://www.ahrq.gov/professionals/systems/long-term-care/resources/hcbs/methods/index.html.
Heather M. Young, Ellen Kurtzman, Martina Roes, Mark Toles, Abigail Ammerman, and Doug Pace, Measurement Opportunities & Gaps: Transitional Care Processes and Outcomes Among Adult Recipients of Long-Term Services and Supports (Washington, DC: Long-Term Quality Alliance, December 2011), http://www.ltqa.org/wp-content/themes/ltqaMain/custom/images/TransitionalCare_Final_122311.pdf.
CMS, Guidance to States using 1115 Demonstrations or 1915(b) Waivers for Managed Long Term Services and Supports Programs (Baltimore, MD: CMS, Center for Medicaid and CHIP Services, May 2013), http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Downloads/1115-and-1915b-MLTSS-guidance.pdf.
For more information about the CLASS Program, see KCMU, Health Care Reform and the CLASS Act (Washington, DC: Kaiser Family Foundation, April 2010), https://www.kff.org/health-costs/issue-brief/health-care-reform-and-the-class-act/.
American Taxpayer Relief Act, Pub. L. No. 112-240, 112th Congress, (January 2, 2013), U.S. Government Printing Office.
Commission on Long-Term Care, Report to the Congress (Washington, DC: Commission on Long-Term Care, September 2013), http://ltccommission.lmp01.lucidus.net/wp-content/uploads/2013/12/Commission-on-Long-Term-Care-Final-Report-9-26-13.pdf.
Long-Term Care Commission, A Comprehensive Approach in Long-Term Services and Supports (Washington, DC: Long-Term Care Commission, September 2013), http://www.medicareadvocacy.org/wp-content/uploads/2013/10/LTCCAlternativeReport.pdf.
Commission on Long-Term Care, Report to the Congress (Washington, DC: Commission on Long-Term Care, September 2013), http://ltccommission.lmp01.lucidus.net/wp-content/uploads/2013/12/Commission-on-Long-Term-Care-Final-Report-9-26-13.pdf.
Susan C. Reinhard, Enid Kassner, Ari Houser, Kathleen Ujvari, Robert Mollica, and Leslie Hendrickson, Raising Expectations 2014: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers (Washington, DC: AARP Public Policy Institute, June 2014), http://www.aarp.org/content/dam/aarp/research/public_policy_institute/ltc/2014/raising-expectations-2014-AARP-ppi-ltc.pdf.
In April 2014, the Bipartisan Policy Center issued a white paper on challenges in financing and delivering LTSS, launching its Long-Term Care Initiative. The Bipartisan Policy Center anticipates it will issue policy recommendations in late 2015 with the objective “to find a politically viable and fiscally sustainable path forward to improve the financing and delivery of LTSS for America’s aging population and working-age Americans with disabilities.” For more information, see “America’s Long-Term Care Crisis: BPC Launches Initiative to Find a Politically and Fiscally Viable Path Forward to Improve the Financing and Delivery of Long-Term Care,” Bipartisan Policy Center, accessed December 10, 2015, http://bipartisanpolicy.org/press-release/americas-long-term-care-crisis-bpc-launches-initiative-find-politically/.
Topics
Also of Interest
- Rebalancing in Capitated Medicaid Managed Long-Term Services and Supports Programs: Key Issues from a Roundtable Discussion on Measuring Performance
- Medicaid Home and Community-Based Services Programs: 2011 Data Update
- Olmstead’s Role in Community Integration for People with Disabilities Under Medicaid: 15 Years After the Supreme Court’s Olmstead Decision
- Medicaid Beneficiaries Who Need Home and Community-Based Services: Supporting Independent Living and Community Integration