Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Publications

10/29/2010

Centers for Medicare & Medicaid Services. (2008). Application for a §1915(c) Home and Community-Based Waiver [Version 3.5]: Instructions, Technical Guide and Review Criteria. Baltimore, MD: Department of Health and Human Services.

This publication contains extensive information concerning Federal policies that apply to the operation of an HCBS waiver, in particular, Appendix B: Participant Access and Eligibility.

Available at https://www.hcbswaivers.net/CMS/faces/portal.jspunder links and downloads, entitled §1915(c) Waiver Application and Accompanying Materials.

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Centers for Medicare & Medicaid Services. State Medicaid Director Letter. August 6, 2010. Improving Access to Home and Community-Based Services.

The purpose of this letter is to inform states of, and provide guidance on, several changes to §1915(i) of the Social Security Act made by the Affordable Care Act. Under §1915(i), states have the option to amend their State Plans to provide home and community-based services without a waiver. These changes, which become effective October 1, 2010, include revised and new §1915(i) provisions for removal of barriers to offering home and community-based services through the Medicaid State Plan.

Available at http://www.cms.gov/smdl/downloads/SMD10015.pdf

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Hendrickson, L., and Kyzr-Sheeley, G. (2008). Determining Medicaid Nursing Home Eligibility: A Survey of State Level of Care Assessment. New Brunswick, NJ: Rutgers Center for State Health Policy.

This study describes the nursing facility level-of-care determination processes for individuals applying for Medicaid coverage of nursing home services. The Appendix provides a brief description of data each state collects, the name of the assessment form, plus contact information for state staff.

Available at http://www.hcbs.org/moreInfo.php/doc/2216

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Zaharia, R., and Moseley, C. (2008). State Strategies for Determining Eligibility and Level-of-Care for ICF/MR and Waiver Program Participants. New Brunswick, NJ: Rutgers Center for State Health Policy.

This report presents the results of a survey of state developmental disabilities agency officials regarding the determination of initial eligibility/level of care and the “annual level of care” for services furnished under Medicaid waiver and ICF/MR programs. Forty-seven states provided information on state waiver eligibility criteria and practices. The report describes state level-of-care assessment approaches and provides legislative citations and contact information for state staff.

Available at http://www.hcbs.org/moreInfo.php/doc/2305

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O’Keeffe, J. (1999). Elderly Persons with Cognitive and Other Mental Impairments: Can They Meet Medicaid Level-of-Care Criteria for Nursing Homes and for Home and Community-Based Waiver Programs? Pub. #9704, Washington, DC: AARP, Public Policy Institute.

This study investigates whether persons ages 65 or older, with functional limitations caused by cognitive and other mental impairments, can meet states’ Medicaid level-of-care criteria for nursing home and HCBS waiver programs. A review of 42 states’ Medicaid level-of-care criteria found that many states do not use measures that appropriately assess the need for services among persons with cognitive and other mental impairments. The report includes a state-by-state description of Medicaid level-of-care criteria relevant for persons with cognitive and other mental impairments. To obtain a free copy of this document, contact AARP’s Public Policy Institute at (202) 434-3840.

Note: Although this and the following publication are more than 10 years old, more recent reports with this level of detail are not available.

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O’Keeffe, J. (1996). Determining the Need for Long-Term Care Services: An Analysis of Health and Functional Eligibility Criteria in Medicaid Home and Community-Based Waiver Programs. Pub. #9617, Washington, DC: AARP, Public Policy Institute.

This report provides, through text and tables, an overview and comparison of the criteria that 42 states use to determine eligibility for nursing home and HCBS waiver programs. To obtain a free copy of this document, contact AARP’s Public Policy Institute at (202) 434-3840.

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