The goal of this report is to identify the individual-level factors associated with nursing home and assisted living entry and determine whether and how they differ. While it is possible to estimate a simple model of entry into these facilities at some point in the observation period, a more useful model would make use of data on elapsed time unti
State Experiences with Minimum Nursing Staff Ratios for Nursing Facilities: Findings from Case Studies of Eight States
This paper reports on (1) what is known about the status of states' minimum nursing staff ratios and (2) findings from case studies that examine states' experiences with implementing or modifying these standards in a selected number of states. A review of the published and unpublished literature on state standards identified 36 states with establi
1 Patient Protection and Affordable Care Act (Public Law 111-148) and Health Care and Education Reconciliation Act of 2010 (Public Law 111-152). 2 “Essential Health Benefits: Individual Market Coverage.” Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, December 16, 2011 accessed
Peter Kemper, Diane Brannon, Brigitt Heier, Jungyoon Kim, Candy Warner, Joe Vasey and Amy Stott Pennsylvania State University, Center for Health Care and Policy Research September 9, 2008 PDF Version: http://aspe.hhs.gov/daltcp/reports/2008/FSSrpt.pdf (69 PDF pages)
Assessing the Need for a National Disability Survey: Final Report. A. Potential Features of a Periodic National Disability Survey
A new, periodic survey focused specifically on disability offers significant potential because, in theory, it could be designed in any manner to address disability data limitations and not be hampered by the structure of existing data collection efforts. Attendees at the FAEP and TAG meetings supported the idea of such a survey but also expressed
Assessing the Need for a National Disability Survey: Final Report. C. Limitations of Existing Data on Disability
Although extensive information pertaining to disability is collected through national surveys and program administrative data, the existing sources of data on disability have a number of shortcomings that limit their usefulness. Gaps and limitations of available disability-related data were identified by the staff of the state and federal agencies
This is the final report of a project that assesses the need for developing and fielding another national disability survey data collection effort. It presents the findings from three principal project activities designed to assess whether existing data are sufficient to answer key disability-related research questions identified by the staffs of
Health, Housing, and Service Supports for Three Groups of People Experiencing Chronic Homelessness. References
Buchanan, D.R., K. Romina, L.S. Sadowski, and D. Garcia. 2009. The health impact of supportive housing for HIV positive homeless patients: A randomized controlled trial. American Journal of Public Health , 99:6. Burt, M.R. 2009. Widening Effects of the Corporation for Supportive Housings System-Change Efforts in Los Angeles, 2005-2008: Hilt
Health, Housing, and Service Supports for Three Groups of People Experiencing Chronic Homelessness. 6. Group 3: Eligible for Specialized MENTAL/BEHAVIORAL Health Services Under Medicaid
The condition known as serious mental illness differentiates Group 3 from Groups 1 and 2. SMI usually involves a diagnosis of psychosis or major affective disorder and duration of at least a year, either already experienced or anticipated. Along with these two elements, the condition must create substantial disability , meaning that it si
This Issue Paper describes three subgroups of the people experiencing chronic homelessness, and the services and housing configurations currently supporting them.
Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. Notes
The Kaiser Commission on Medicaid and the Uninsured has published Medicaid: a Primer which explains key information about the Medicaid program. This publication, available at http://www.kff.org/medicaid/upload/7334-04.pdf provides clear explanations about Medicaid for readers who want more information about mandatory and optional benefits,
Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 6.5. Challenges, Obstacles, and Limitations of Home and Community-Based Services
While it would appear that state efforts to enable people with disabilities to live in non-institutional, community-based settings should align with efforts to use PSH to end homelessness for people with poor health and high levels of disability, often that is not the case. 6.5.1. Separate Service-Providers, Advocates, and Government Organiza
Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 6.4. How Can Home and Community-Based Services be Provided to Permanent Supportive Housing Residents?
For the most part, people living in institutional settings are not homeless, although a growing number of older and vulnerable homeless adults are entering nursing homes or other long-term care facilities, often after a period of inpatient hospitalization for an acute medical and/or psychiatric crisis.
Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 6.1. Home and Community-Based Services (1915c) Waiver Services
States may operate several different HCBS 1915c waiver programs, each designed to target different groups of people based on age, diagnosis, or condition. States may also receive a waiver of Medicaids statewideness requirements and offer some HCBS waiver services in a particular jurisdiction or region of the state or operate statewide but se
Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 6. Home and Community-based Services
Medicaid-covered HCBS may be available under an HCBS waiver (1915c) or they may be optional HCBS services covered without a waiver under a Medicaid SPA (1915i). HCBS are intended to offer alternatives to institutional care for people with disabling health conditions.
Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 1.6. The Rest of This Paper
Based on the results of site visits and telephone interviews conducted in early 2011, 12 this paper describes several different service approaches and financing mechanisms that have already been implemented or are in development to provide Medicaid reimbursement for services for chronically homeless people and residents of PSH. The remaining
Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 1.2. Who is Eligible for Medicaid?
Until the ACA is fully implemented in 2014, Medicaid eligibility is based on income and also is categorical. Only some income-eligible people are in eligible categories defined by age, disability, or eligibility for another program. Among chronically homeless people, Medicaid eligibility is usually dependent on having a disability that makes t
Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. Highlights
This paper describes the specific ways in which Medicaid reimbursement is being used for some of the services provided to chronically homeless people, including services that address their health and behavioral health needs and help vulnerable people get and keep stable housing. States have used different types of Medicaid benefits and payment mec
Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities
This Issue Paper describes the ways that Medicaid is being used now and might be used in the future under provisions of the Affordable Care Act of 2010 to serve chronically homeless people. [67 PDF pages]