Community-Based Services for People With Brain Injury: A National Analysis

2018 ◽  
Vol 32 (2) ◽  
pp. 123-138 ◽  
Author(s):  
Carli Friedman ◽  
Laura VanPuymbrouck
Keyword(s):  
Brain Injury ◽  
Underserved Populations ◽  
Fiscal Year ◽  
Community Based ◽  
Institutional Settings ◽  
Services And Supports ◽  
National Analysis ◽  
Community Based Services

Purpose:Where and how rehabilitation and long-term services and supports (LTSS) occur for individuals with brain injury (BI) has shifted dramatically over the last few decades. Medicaid Home and Community Based Services (HCBS) 1915(c) waivers allow states to offer LTSS that is tailored to the needs of underserved populations in the community rather than institutional settings.Method:This study examined how states utilized waivers to provide for people with BI.Results:Findings revealed only 15 states had waivers for people with BI in fiscal year 2016.Conclusions:Of those waivers for people with BI, there were vast differences across states and services.

Day Habilitation Services for People With Intellectual and Developmental Disabilities in Medicaid Home and Community-Based Services Waivers

2016 ◽  
Vol 41 (4) ◽  
pp. 244-255 ◽  
Author(s):  
Carli Friedman
Keyword(s):  
Developmental Disabilities ◽  
Service Utilization ◽  
Fiscal Year ◽  
Intellectual And Developmental Disabilities ◽  
Community Based ◽  
Total Spending ◽  
Day Habilitation ◽  
Services And Supports ◽  
Community Based Services

Medicaid Home and Community-Based Services (HCBS) 1915(c) waivers are one of the largest providers of long-term services and supports for people with intellectual and developmental disabilities (IDD). HCBS waivers also play a prominent role in providing day habilitation services for people with IDD. The purpose of this study was to examine how HCBS waivers allocate day habilitation services for people with IDD. HCBS waivers providing day habilitation services for people with IDD were analyzed to determine service utilization and projected expenditures. In fiscal year 2014, HCBS waivers projected US$5.62 billion of funding for day habilitation services; however, there was wide variance across services in terms of projected total spending, spending per participant, and reimbursement rates.

A National Analysis of Medicaid Home and Community Based Services Waivers for People With Intellectual and Developmental Disabilities: FY 2015

2017 ◽  
Vol 55 (5) ◽  
pp. 281-302 ◽  
Author(s):  
Carli Friedman
Keyword(s):  
Developmental Disabilities ◽  
National Level ◽  
Intellectual And Developmental Disabilities ◽  
Community Based ◽  
Day Habilitation ◽  
Services And Supports ◽  
National Analysis ◽  
Regulation Changes ◽  
Community Based Services

Abstract Medicaid Home and Community Based Services (HCBS) 1915(c) waivers are the largest source of funding for the long term services and supports of people with intellectual and developmental disabilities (IDD). National-level analyses of HCBS IDD waivers are crucial because of the large variance across states, the recent CMS rule and regulation changes (CMS 2249-F/2296-F), and the ever changing economic and political landscape. Therefore, the aim of this study was to examine state waiver priorities for people with IDD. In FY 2015, 111 waivers projected spending $25.6 billion for approximately 630,000 people with IDD. The services with the most funding were residential habilitation, supports to live in one's own home, and day habilitation. However, our analysis revealed large discrepancies across states and services.

Aging in Place: A National Analysis of Home- and Community-Based Medicaid Services for Older Adults

2018 ◽  
Vol 29 (4) ◽  
pp. 245-256 ◽  
Author(s):  
Carli Friedman ◽  
Joe Caldwell ◽  
Angela Rapp Kennedy ◽  
Mary C. Rizzolo
Keyword(s):  
Older Adults ◽  
Aging In Place ◽  
Nursing Facilities ◽  
Community Based ◽  
Age In Place ◽  
Services And Supports ◽  
Aging Adults ◽  
National Analysis ◽  
Community Based Services

The number of Americans needing long-term services and supports (LTSS) is projected to more than double in the coming decades largely due to an aging baby boomer population, meaning paying for LTSS will become an even greater challenge for American families and the country. Despite the benefits of aging in place, there remains a long-standing institutional bias within the Medicaid program, where services in nursing facilities are mandatory while home- and community-based services (HCBS) are mostly optional for states to cover. This study examined HCBS 1915(c) waivers ( n = 61 waivers) for older adults to categorize and compare service priorities. Findings revealed waivers for older adults were primarily focused on supporting individuals in their own homes to age in place. However, findings also revealed HCBS waivers are an underutilized mechanism for funding the LTSS of older adults. As states continue to deal with an increasing population of aging adults, with and without disabilities, the HCBS waiver option will continue to be an important component of a state’s service system.

Persons with brain injury and employment supports: Long-term employment outcomes and use of community-based services

Brain Injury ◽  
2017 ◽  
Vol 31 (5) ◽  
pp. 607-619 ◽  
Author(s):  
Alisa Grigorovich ◽  
Mary Stergiou-Kita ◽  
Thecla Damianakis ◽  
Guylaine Le Dorze ◽  
Carolyn Lemsky ◽  
...  
Keyword(s):  
Brain Injury ◽  
Employment Outcomes ◽  
Community Based ◽  
Employment Supports ◽  
Community Based Services

Long-Term Services and Supports for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care

2015 ◽  
pp. 150527102958001 ◽  
Author(s):  
Andrea Wysocki ◽  
Mary Butler ◽  
Robert L. Kane ◽  
Rosalie A. Kane ◽  
Tetyana Shippee ◽  
...  
Keyword(s):  
Older Adults ◽  
Institutional Care ◽  
Community Based ◽  
Services And Supports ◽  
Community Based Services

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

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.

scholarly journals Factors Explaining State Differences in Applying for a Recent Long-Term Care Program that Promotes Aging in Place: Perspectives of Medicaid Administrators

2020 ◽  
pp. 073346482092451
Author(s):  
Esther M. Friedman ◽  
Regina A. Shih ◽  
Sangeeta C. Ahluwalia ◽  
Virginia I. Kotzias ◽  
Jessica L. Phillips ◽  
...  
Keyword(s):  
Long Term Care ◽  
Aging In Place ◽  
Care Program ◽  
Community Based ◽  
Term Care ◽  
Incentive Program ◽  
Policy Goals ◽  
Services And Supports ◽  
Community Based Services

Older adults in need of assistance often prefer to remain at home rather than receive care in an institution. To meet these preferences, Medicaid invited states to apply for the Balancing Incentive Program (BIP), a program intended to “rebalance” Medicaid-financed long-term services and supports to Home- and Community-Based Services (HCBS). However, only about half of eligible states applied. We interviewed Medicaid administrators to explore why some states applied for BIP whereas others did not. Supportive state leadership and the presence of other programs supporting community-based care were positively related to BIP application. Opposing policy priorities and programs competing for similar resources were negatively related to BIP application. Because states most likely to apply already had policy goals and programs supporting HCBS, BIP may inadvertently widen disparities across states, pushing those on the margins ahead and leaving the ones that are worst off in HCBS support to fall even further behind.

Stakeholders’ Home and Community Based Services Settings Rule Knowledge

2017 ◽  
Vol 43 (1) ◽  
pp. 54-61
Author(s):  
Carli Friedman
Keyword(s):  
Community Integration ◽  
People With Disabilities ◽  
Medicaid Program ◽  
Community Based ◽  
Transition Plans ◽  
Rule Knowledge ◽  
Key Stakeholders ◽  
Services And Supports ◽  
Community Based Services

Medicaid Home and Community Based Services (HCBS) waiver programs provide the majority of long-term services and supports for people with intellectual and developmental disabilities (IDD). Relatively new (2014) HCBS rules (CMS 2249-F/2296-F) governing these programs require meaningful community integration of people with disabilities who receive services under this Medicaid program. States are required to develop and submit transition plans, which document how their programs will meet the so-called settings rules. Public comment periods provide advocates the opportunity to impact states’ rules by ensuring that plans are truly community based. Yet the lengthy and technical description of the rules may be inaccessible for people with disabilities and their allies. Because knowledge of the HCBS settings rules can be crucial for people with IDD to enable them to access their rights, the aim of this study was to explore HCBS settings rules knowledge of people with IDD and key stakeholders. Our findings confirmed that there is a need to make the HCBS settings rules more accessible to those most affected by the changes—people with IDD and family members of people with IDD. Doing so is a necessary first step to promote advocacy regarding its implementation.

Outdated Language: Use of “Mental Retardation” in Medicaid HCBS Waivers Post-Rosa's Law

2016 ◽  
Vol 54 (5) ◽  
pp. 342-353 ◽  
Author(s):  
Carli Friedman
Keyword(s):  
Mental Retardation ◽  
Federal Government ◽  
Language Use ◽  
Community Services ◽  
Intellectual And Developmental Disabilities ◽  
Federal Programs ◽  
Community Based ◽  
Services And Supports ◽  
Community Based Services

Abstract Rosa's Law, which changed references of “mental retardation” to “intellectual disability” within federal legislation, marked recognition by the federal government that the term “mental retardation” is outdated and pejorative. However, Rosa's Law did not apply to many notable federal programs related to disability, such as Medicaid. This article explores if and how the term “mental retardation” was used within Medicaid Home and Community Based Services 1915(c) waivers, as they are the most prevalent provider of long-term services and supports for people with intellectual and developmental disabilities. Waivers provide some of the most advanced community services and the language used in them should reflect this. Although an overwhelming majority of waivers used “mental retardation,” we found that the term was used less for later benchmark dates.

scholarly journals Expanding Medicaid Coverage for Community-Based Long-Term Services and Supports: Lessons From Maryland’s Community First Choice Program

2018 ◽  
Vol 39 (7) ◽  
pp. 745-750
Author(s):  
Julia Burgdorf ◽  
Jennifer Wolff ◽  
Amber Willink ◽  
Cynthia Woodcock ◽  
Karen Davis ◽  
...  
Keyword(s):  
Community Settings ◽  
Personal Care ◽  
Community Based ◽  
Policy Makers ◽  
Care Services ◽  
First Choice ◽  
Services And Supports ◽  
State Plan ◽  
Community Based Services

Community First Choice (CFC) is a Medicaid state plan option authorized through the Affordable Care Act (ACA) that supports the delivery of long-term services and supports in home and community settings. We interviewed stakeholders in Maryland, one of the first states to adopt CFC, to assess challenges, benefits, and potential implications of this Medicaid option for state and federal policy makers. Study findings suggest that expanding coverage for home- and community-based services through CFC in Maryland has been financially feasible, expanded the personal care workforce, and supported a more equitable approach to personal care services. We conclude that greater coverage for home- and community-based long-term services is a promising avenue to improve access to care for high-need Medicaid beneficiaries.

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