Learning From New State Initiatives in Financing Long-Term Services and Supports

Abstract A number of states are taking concrete action on long-term services and supports (LTSS) financing which provides an opportunity to learn about the reasons why they are doing so, to identify the coalitions that have come together in support of such actions, and to understand factors associated with the choice of particular strategies and approaches. The purpose of the presentation is to report on a comparative qualitative study across six leading-edge states—Washington State, Hawaii, Maine, Minnesota, California, and Michigan—in order to describe their activities and identify and analyze commonalities and differences in their specific approaches and programs. An overarching goal is to help state officials, consumer advocates, and interested LTSS providers understand the strategies and approaches that other states—who may be further along in their development—are taking in this area so that they might have insights into strategies that might be a fit for their state.

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Factors Associated With Changes in Perceived Quality of Life Among Elderly Recipients of Long-Term Services and Supports

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2015.07.019 ◽

2016 ◽

Vol 17 (1) ◽

pp. 44-52 ◽

Cited By ~ 23

Author(s):

Mary D. Naylor ◽

Karen B. Hirschman ◽

Alexandra L. Hanlon ◽

Katherine M. Abbott ◽

Kathryn H. Bowles ◽

...

Keyword(s):

Quality Of Life ◽

Perceived Quality ◽

Factors Associated ◽

Perceived Quality Of Life ◽

Elderly Recipients ◽

Services And Supports

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Promises and Pitfalls of Health Information Technology for Home- and Community-Based Services

Journal of Applied Gerontology ◽

10.1177/0733464820941364 ◽

2020 ◽

pp. 073346482094136

Author(s):

Sangeeta C. Ahluwalia ◽

Esther Friedman ◽

Daniel Siconolfi ◽

Debra Saliba ◽

Jessica Phillips ◽

...

Keyword(s):

Information Technology ◽

Health Information Technology ◽

Health Information ◽

Service Agency ◽

Community Based ◽

Incentive Program ◽

Services And Supports ◽

Consumer Advocates ◽

Community Based Services

Background: Health information technology (HIT) use in home- and community-based services (HCBS) has been hindered by inadequate resources and incentives to support modernization. We sought to understand the ways the Medicaid Balancing Incentive Program (BIP) facilitated increased use of HIT to increase access to HCBS. Method: Qualitative analysis of interviews with 30 Medicaid administrators, service agency providers, and consumer advocates. Results: Although stakeholders perceived several benefits to greater HIT use, they highlighted critical challenges to effective adoption within the long-term services and supports (LTSS) system, including lack of extant expertise/knowledge about HIT, the limited reach of HIT among rural and disabled beneficiaries, burdensome procurement processes, and the ongoing resources required to maintain up-to-date HIT solutions. Conclusion: The structural reforms required by BIP gave states an opportunity to modernize their HCBS systems through use of HIT. However, barriers to HIT adoption persist, underscoring the need for continued support as part of future rebalancing efforts.

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BARRIERS AND FACILITATORS TO IMPLEMENTING THE BALANCING INCENTIVE PROGRAM (BIP)

Innovation in Aging ◽

10.1093/geroni/igz038.559 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S156-S156

Author(s):

Lisa Beauregard ◽

Edward A Miller

Keyword(s):

Structural Changes ◽

Internal State ◽

Barriers And Facilitators ◽

Structured Interviews ◽

Incentive Program ◽

Key Stakeholders ◽

Services And Supports ◽

Consumer Advocates ◽

Community Based Services

Abstract The Balancing Incentive Program (BIP) was an optional Medicaid program within the Affordable Care Act. States spending less than 50% of Medicaid long-term services and supports on home and community-based services (HCBS) were eligible for the program and could participate from 2011 to 2015. Participating states received an enhanced federal match in exchange for rebalancing LTSS spending and adopting structural changes to their long-term services and supports system. The purpose of this study is to understand the barriers and facilitators to implementing the BIP in two states. Data was collected through semi-structured interviews with individuals involved in HCBS policy nationally and in Maryland and Texas, including government bureaucrats, consumer advocates, and provider representatives. Findings indicate that factors that facilitated Maryland and Texas’ implementation of the BIP were regular communication with the Centers for Medicare and Medicaid Services and their consultants, Mission Analytics Group, merging the BIP with existing HCBS programs, and the substantial amount of funding associated with the program. On the other hand, the short duration of the BIP presented a challenge for states because they needed to enact multiple changes within a limited period of time. In addition, state procurement and contracting processes impeded the speed with which BIP requirements could be met. Key stakeholders, including consumer advocacy and provider organizations, often felt as though their state implemented the BIP with minimal input from interested groups. The findings indicate that the structure of the Balancing Incentive Program as well as internal state factors influenced the program’s implementation.

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Factors Associated With State Mandate of Nursing Home Staff Testing During COVID-19

Innovation in Aging ◽

10.1093/geroni/igab046.959 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 249-249

Author(s):

Edward Miller ◽

Molly Wylie ◽

Lisa Beauregard ◽

Pamela Nadash ◽

Michael Gusmano ◽

...

Keyword(s):

At Risk ◽

State Government ◽

Supply And Demand ◽

Factors Associated ◽

For Profit ◽

State Mandate ◽

Government Ideology ◽

At Risk Populations ◽

Services And Supports

Abstract COVID-19 has presented challenges for nursing homes (NHs) and other congregate living settings which serve older adults at high risk for morbidity and death from the virus. This study identified factors associated with states’ adopting a mandate for regular staff testing for COVID-19 in NHs. Potential correlates included state government ideology and capacity, NH supply and demand, prevailing economic conditions, existing state policies, and NH characteristics. Findings indicate that percent for profit NHs is most strongly associated with adoption of a state staff testing mandate. Governing capacity (average legislative salary), percent population at risk for COVID-19, and existing public policy (percent Medicaid spending devoted to long-term services and supports (LTSS) were also associated with the probability of adoption. Based on these results, states with more proprietary facilities and greater capacities for government action, investment in Medicaid LTSS, and at-risk populations were more likely to mandate regular staff testing in NHs.

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