Reports & Publications

November 2017
Carrie Graham, Mel Neri, Brooke Hollister, Marian Liu, Stephen Kaye, Edward Bozwell Bueno, Winston Tseng, and Charlene Harrington
The Cal MediConnect logo

Researchers from the University of California have conducted an evaluation of the impact of the Cal MediConnect (CMC) program on beneficiaries and health systems. One goal of CMC was to decrease expenditures through incentives to redirect care away from institutional settings and toward more home- and community-based services (HCBS). This research brief includes results from an in-depth examination of the efforts of CMC health plans to administer HCBS through their new managed long-term services and supports programs.

November 2017
Ari Ne'eman
A map of the U.S. showing states with managed LTSS programs in blue and the other states in gray.

Over the course of the last decade, the United States has seen a significant increase in the use of Managed Long Term Services and Supports (MLTSS) within the Medicaid program. In order to ensure that MLTSS systems deliver high-quality services to people with disabilities and do not involve inadequate or overly medicalized service provision, states adopt certain requirements within their procurement for and contracting with MCOs.

July 2017
H. Stephen Kaye
A line graph titled, "Figure 1. Average annual HCBS spending per non-I/DD enrollee, 2001–13, actual and reduced as if BCRA caps had been in place."  A blue line shows the average national per-enrollee HCBS spending for programs targeted to people without I/DD. Beginning in 2005, a green and a red line diverge from the blue line, showing the impact that per capita caps might have had.  By 2013, the green line is 23% lower and the red line 30% lower than the blue line.

The Better Care Reconciliation Act (BCRA) proposes to cap Federal Medicaid reimbursements to the states on a per-enrollee basis, effectively limiting growth to a rate at first only modestly exceeding the rate of inflation in healthcare costs and then falling below inflation. If the BCRA were to be enacted, it is reasonable to assume that most states would limit home and community-based services (HCBS) spending to the per-enrollee cap amount; otherwise, any excess comes entirely out of the state budget.

September 2017
Stephen Campbell
Circular logo with text "PHI:  Quality Care Through Quality Jobs"

Arizona is among just 19 states that have enacted uniform training requirements for personal care aides (PCAs) across all Medicaid long-term care programs. The process by which the state adopted these training standards spanned from 2004 to 2012. During that time, home care leaders deliberated extensively over how to achieve a system that ensured a baseline level of competency among PCAs, while balancing the priorities of workers, consumers, providers, and the state. What was the need for PCA training standards in Arizona? How did home care leaders address that need?

October 2017
Stephen Campbell

In Iowa, training requirements for personal care aides are minimal compared to training requirements for home health aides and nursing assistants. Since 2006, Iowa’s long-term care leaders have been striving to create a competency-based training and certification system that spans all direct care workers and ensures high-quality care across populations and settings. While state lawmakers haven’t enacted training requirements for personal care aides, Iowa’s long-term care leaders have achieved promising results.

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