Understanding Home and Community-Based Long-Term Services and Supports: An Evaluation of Medicaid's Balancing Incentive Program

2019 ◽  
Author(s):  
Yan Wang
Keyword(s):  
Community Based ◽  
Incentive Program ◽  
Services And Supports

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.

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

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.

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

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.

scholarly journals AGING IN PLACE: REVISITING OLD ASSUMPTIONS ABOUT WHAT PEOPLE WANT AS THEY GROW OLD

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S601-S601
Author(s):  
Marc A Cohen ◽  
Robyn Stone ◽  
Ruth Katz
Keyword(s):  
Nursing Homes ◽  
Representative Sample ◽  
Aging In Place ◽  
Cognitively Impaired ◽  
Community Based ◽  
Age In Place ◽  
Institutional Services ◽  
Nationally Representative ◽  
Services And Supports

Abstract When people are asked how and where they would like to age, they overwhelmingly indicate they want to “age in place”, that is, in their own homes. To support this desire, a range of home and community-based service options have been developed accompanied with major declines in the use of nursing homes and other institutional services. However, what if we’ve been asking the wrong question? Or asking the wrong people? Given that upwards of 70% of people turning age 65 will have a need for long-term services and supports (LTSS) and 52% will have significant need, the more relevant question is: how might you want to age in the presence of LTSS needs? In this research we explore the attitudes and expectations of a nationally representative sample of 1,200 “late Boomers” age 60 to 72 (instead of all adults) regarding how they want their life to look should they become physically or cognitively impaired and need LTSS. The analytic sample was derived from NORC’s AmeriSpeak® Panel. We found that in the presence of significant LTSS need, many people -- 40% if physically disabled and 71% if cognitively impaired -- do not want to remain at home. More than anything else they value safety and do not want to burden their families. They are also concerned about feeling alone. Clearly, late boomers understand that there are circumstances where aging in place may not be right for them and implications for the way we invest resources in the service infrastructure.

scholarly journals THE PORCHLIGHT PROJECT: PARTNERING WITH VOLUNTEERS TO ENHANCE COMMUNITY-BASED DEMENTIA CARE AND OUTREACH

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S795-S795
Author(s):  
Joseph E Gaugler ◽  
Christina Rosebush ◽  
Gabriela Bustamante ◽  
Jeri Schoonover ◽  
Roxanne Jenkins ◽  
...  
Keyword(s):  
Older Persons ◽  
Large Scale ◽  
Dementia Care ◽  
Negative Effects ◽  
Community Based ◽  
Care And Support ◽  
Training Approach ◽  
Potential Success ◽  
Services And Supports

Abstract Families often remain unaware of long-term services and supports (LTSS) that could help to mitigate the negative effects of Alzheimer’s disease and related dementias (ADRDs). Approaches that: a) identify community-residing older persons with potential memory impairment; b) assist their families in navigating the healthcare system; and c) facilitate the identification of appropriate community-based LTSS could result in more effective management of ADRD. The Porchlight Project is a multicomponent training approach for lay volunteers in Minnesota (i.e., Senior Companions) that enhances their capability to deliver dementia care and support to underserved older persons in need. Mixed methods analysis of qualitative and quantitative data among 20 Senior Companions and up to 25 persons with ADRD and their family caregivers suggest the potential success of the Porchlight Project, as well as areas to refine and enhance prior to large-scale evaluation throughout Minnesota.

scholarly journals Fireside Chats During COVID-19: Caregiver Community-Based Education

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 946-946
Author(s):  
Kara Dassel ◽  
Rand Rupper ◽  
Jorie Butler ◽  
Jacqueline Telonidis ◽  
Catherine Witt ◽  
...  
Keyword(s):  
Community Based ◽  
Community Partners ◽  
Community Based Education ◽  
Advance Care ◽  
The Mean ◽  
Services And Supports ◽  
Strongly Agree ◽  
Level Of Agreement ◽  
Better Than

Abstract The Utah Geriatric Education Consortium (UGEC) provides education about Age-Friendly Health Care and Dementia-Friendly Communities to both informal and professional caregivers. As such, we have collaborated with our community partners to hold 12 “Fireside Chats” (2 in person, and 10 virtually due to COVID-19) between December 2019 and September 2020. Our expert speakers and panelists have given presentations on a variety of topics, specifically focused on coping with COVID-19, such as physical, music, and arts-based activities to do in the home, advance care planning, local services and supports, resiliency, and mindfulness. A total of 463 participants attended the Fireside Chats. A total of 169 attendees completed evaluations regarding the programs (a completion rate of 37%). Attendees were primarily White (86%), non-Hispanic (95%), well educated (86% had a college degree or higher), about half of the group were community caregivers (55%), while the other attendees were primarily from health professional backgrounds (e.g., nursing, social work, physical therapy). We obtained evaluation data in seven domains based on a 5-point Likert scale (1=strongly disagree to 5=strongly agree). The mean level of agreement in the seven following domains were: satisfaction (M=4.68/SD=.53), effectiveness (M=4.72/SD=.52), met stated goals (M=4.70/SD=.53), met educational needs (M=4.64/SD=.6), will improve the care they provide (M=4.57/SD=.70), included useful examples (M=4.59/SD=.66), and was better than similar trainings (M=4.23/SD=.86). These results along with steady attendance of our “Fireside Chats” demonstrate the need and satisfaction with our community-based education based on improving geriatric care practices within the community and in long-term services and support programs.

scholarly journals State Medicaid Policy and LTC: A Multi-State Qualitative Study of Policy Influence on Caregiver Experiences

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 105-105
Author(s):  
Tonie Sadler ◽  
Kevin Yan ◽  
Daniel Brauner ◽  
Harold Pollack ◽  
R Tamara Konetzka
Keyword(s):  
Qualitative Interviews ◽  
Community Based ◽  
Specific Knowledge ◽  
Term Care ◽  
Evaluation Procedures ◽  
Medicaid Policy ◽  
Caregiver Experiences ◽  
Community Trust ◽  
Services And Supports

Abstract This study focuses on long-term care (LTC) state Medicaid policy and its impact on caregiver decisions and experiences. It examines respondents’ general knowledge of LTC state policies and services, challenges with navigating LTC policies and services, and decision-making pathways based on these factors. Using purposive sampling, 63 family caregivers across eight states participated in open-ended qualitative interviews (2019-2020) until thematic saturation was reached. Questions broadly examined caregivers’ experiences and decisions, focusing on decisions made around type of care setting and experiences with LTC state policy. States were selected to represent variation in Home and Community Based Service (HCBS) expenditures as a percentage of total Medicaid long-term services and support expenditures. While LTC policies and services vary significantly by state, we identified many parallels in caregiver experiences and perceptions across states, as respondents often lacked specific knowledge about LTC policies and services and how to access them. Overarching themes include LTC policy navigation challenges, distrust in state-funded LTC services and supports, and moral expectations of caregiving. To manage these challenges, caregivers employed coping strategies such utilizing informal support networks, hiring care coordination assistance, and “stretching things thin” to fill the policy and service gaps. Study findings highlight potential strategies to improve LTC services across states. There is a need to improve community trust with state services by employing transparent regulatory and evaluation procedures for LTC. Wider access to case management may improve communication and knowledge of available services to maximize benefit from HCBS expansions.

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