Waivers

Disease Management and Medicaid Waiver Services for HIV/AIDS Patients. References

Baldwin III, A. L. (1999). Research Report: Financial and Risk Considerations for Successful Disease Management Programs. Seattle, WA: Milliman & Robertson, Inc. Billings, J. & Mijanovich, T. (2007). Improving the Management of Care for High-Cost Medicaid Patients. Health Affairs, 26(6):1643-1655. Bruen, B.K. & Miller, L.M. (2008).

Disease Management and Medicaid Waiver Services for HIV/AIDS Patients. Appendix B

Reported AIDS Cases in States with Programs Targeted to HIV/AIDS State Reported AIDS Cases Alabama 8,252 California 139,019 Colorado 8,480 Delaware 3,458 District of Columbia 16,962 Florida

Disease Management and Medicaid Waiver Services for HIV/AIDS Patients. Appendix A

Approved Medicaid Waivers Offering Services Targeted to Individuals with HIV/AIDS

Disease Management and Medicaid Waiver Services for HIV/AIDS Patients. Conclusion

To date, there is no broad evidence base to support the assumption that disease management improves health outcomes and can reduce the cost of care for populations with multiple chronic illnesses. Most of the evidence currently available about DM is for diabetes, asthma, congestive health failure, and chronic obstructive pulmonary disease &nda

Disease Management and Medicaid Waiver Services for HIV/AIDS Patients. Disease Management for HIV/AIDS

Antiretroviral treatment has extended the lifespan of people with HIV infection, and more people become infected with HIV than die from the disease each year. Since the mid-1990s, the age-adjusted HIV death rate has declined by more than 70 percent (Kaiser Family Foundation, 2008). As more people with HIV infection live longer, the demand for HIV

Disease Management and Medicaid Waiver Services for HIV/AIDS Patients. Medicaid Disease Management

A 2003 study of three Medicaid DM programs (for all chronic conditions, not HIV-specific DM) indicated that the states’ varied program designs produced short-term net savings and improved outcomes in their patient populations (Gillespie & Rossiter, 2003). Because of the variability in the programs reviewed and the range of chronic co

Disease Management and Medicaid Waiver Services for HIV/AIDS Patients. Disease Management for Complex Medical Conditions

In January 2008, the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) convened an expert panel to discuss outcomes measurement issues related to DM for populations with chronic conditions. The panel included researchers and clinicians, and the discussion noted that the inconsistency in methodologies used to evaluate DM prog

Disease Management and Medicaid Waiver Services for HIV/AIDS Patients. Disease Management: Findings from the Literature

Mixed results from studies of disease management programs in general indicate there is no conclusive evidence of the impact of the programs on cost-effectiveness and health outcomes. According to the Congressional Budget Office’s 2004 analysis of disease management studies for several chronic diseases, there is insufficient evidence to c

Disease Management and Medicaid Waiver Services for HIV/AIDS Patients. Background

The prevalence of chronic disease in the U.S. is a significant public health issue. About 133 million people, almost half of all Americans, have at least one chronic health condition – for example, heart disease, asthma, or diabetes. The Centers for Disease Control and Prevention (CDC) estimates that chronic diseases account for 70% of a

Disease Management and Medicaid Waiver Services for HIV/AIDS Patients. Introduction

Disease management (DM) refers to a system of coordinated health care interventions and communications to help patients self-manage their chronic diseases and prevent complications from these health conditions. DM has been touted by vendors as an effective tool to reduce health care costs. Some DM vendors have claimed that disease management progr

Disease Management and Medicaid Waiver Services for HIV/AIDS Patients. Executive Summary

Disease management (DM) is a system of coordinated health care interventions and communications to help patients self-manage their chronic diseases and prevent complications from these health conditions.

Disease Management and Medicaid Waiver Services for HIV/AIDS Patients

This paper examines the limited evidence to date on the impact of disease management (DM) for low-income populations enrolled in public insurance programs, and explores issues concerning the effectiveness of DM targeted to people living with HIV/AIDS.

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Service Payment Rates: Adequacy Concerns

Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Service Payment Rates: Adequacy Concerns

Unless the monthly rate is considered reasonable by assisted living facilities, they will not be willing to contract with Medicaid. In some states, rates in the $1500-$2500 a month range may be needed to attract enough facilities to serve Medicaid beneficiaries. When considering what rate might be necessary and reasonable, states might sample the

Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Assisted Living and the Medically Needy

Medically needy beneficiaries are persons who, except for income, would qualify in one of the other Medicaid eligibility categories (such as being over age 65 or meeting the SSI disability criteria). Medicaid payments can begin for this group once they have spent down--that is, incurred expenses for medical care in an amount at least equal to the

Income Supplementation by Family Members or

Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Income Supplementation by Family Members or Trusts for Payment of Room and Board

When the beneficiary is unable to pay all room and board costs, family members may be willing to help pay them and other expenses not covered by Medicaid. A trust's funds may also be used to help pay for a beneficiary's costs not covered by Medicaid. However, families and trustees need to be aware of how any funds they contribute may affect benefi

Assisted Living and the Special Income Limit:

Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Assisted Living and the Special Income Limit: Post-Eligibility Treatment of Income

Some states cover persons in an HCBS waiver program using the so-called 300 percent of SSI eligibility option (a person's income must be at or below 300 percent of the maximum SSI benefit--roughly $1500 per month.) This option is attractive for waiver programs that include assisted living, because it expands the program to include beneficiaries wh

Enabling Beneficiaries to Pay for Room and Board

Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Enabling Beneficiaries to Pay for Room and Board

Payment for room and board is one of the critical issues for states seeking to expand assisted living for Medicaid beneficiaries. Surveys by national associations have found that care in assisted living facilities may be unaffordable for many low-income individuals. Monthly fees in market rate facilities range from $800 to over $3500--with the maj

Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Licensing and Contracting Issues

State licensing rules set the minimum requirements for Medicaid providers. The Medicaid program may set more stringent standards if desired, however. For example, some states allow facilities to offer rooms shared by two, three, or more residents. But since one of the purposes of assisted living is to foster independence and autonomy, some state M

Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Level of Care and Licensing Rules

HCBS waiver regulations require that any facility in which waiver services are furnished must meet applicable state standards. When services are furnished by the assisted living facility, the facility must meet the standards for service provision that are set forth in the approved waiver documents. Thus, states planning to cover assisted living th

Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Type of Waiver

When using the waiver program approach, should states add assisted living as a new service to an existing waiver program or implement it under a separate waiver program? From one perspective, adding to an existing waiver program is simple and minimizes reporting and tracking requirements. However, advocates for home and community services may perc

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