Consumer Voices Matter: Meaningful Engagement of Consumers and Caregivers in Long-Term Care

Patient-centered care is responsive to the needs and values of the individuals receiving care, and is one aspect of a high-performing, high-quality health care system. The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule that gives Medicaid managed care consumers and their family caregivers a seat at the table by requiring states to include consumer and family caregiver perspectives in the design, implementation and oversight of state-managed long-term services and supports (LTSS) programs. States should view the new …

Are We There Yet? Efforts to Balance Long-Term Services and Supports

“Marvin L. Dawkins was a 53-year-old AT&T manager when a blocked blood vessel left him paralyzed. It took 11 years, one lawsuit, repeated tangles over Medicaid rules — and a chance meeting on a church van — before he could extract himself from a nursing home outside Baltimore. Now he lives in an apartment with the assistance of an aide, gets out for a job that he says gives him purpose, socializes with new friends and old ones, and revels …

Building Capacity to Provide Behavioral Health Services to Dual Eligibles

The Centers for Medicare & Medicaid Services (CMS) launched the Financial Alignment Initiative (the Initiative) to improve the quality of care received by low-income adults who are eligible for Medicare and Medicaid — known as dual eligibles. Many of these individuals have unmet behavioral health needs, ranging from mild depression to serious mental illness, like schizophrenia and bipolar disorder. A recent update on the Initiative presented to the Medicare Payment Advisory Commission highlighted four challenges to providing behavioral health services …

Gaining New Ground: Solutions for Financing Long-Term Services & Supports

There is little dispute that the cost of long-term services and supports (LTSS) is daunting. The typical cost for care in a nursing home is about $91,250 a year, and the average annual base price for assisted living is $43,200. Few people can accumulate sufficient savings, even over a lifetime, to cover the costs. Most people rely on their families and friends for the bulk of their LTSS needs. Yet, family caregivers cannot do it all, and in the future, …

Covering Low-Income Midlife Adults Through Medicaid: Making Progress, but More States Need to Take the Plunge

The Affordable Care Act — as interpreted by the U.S. Supreme Court — gives states the option to expand Medicaid. Access to Medicaid significantly reduces the number of uninsured in this country. Since the expansion began, millions of individuals are receiving coverage through Medicaid or the Children’s Health Insurance Program. Yet, 19 states have not expanded Medicaid coverage, potentially leaving almost 2 million low-income midlife adults (ages 45-64) without access to insurance coverage. Being uninsured is especially hard on adults …

Can You Afford the Health Care You Need?

Imagine this: You’ve been unemployed for a year and, as a result, don’t have health insurance. You have type 2 diabetes. You need blood tests, but they cost $600 and you can’t afford that. You have a broken tooth that you can’t get fixed. You want to work, but no matter how hard you try, you haven’t been able to find a job. Unfortunately, nearly 3 million hardworking Americans may face scenarios like this. When the decision to expand affordable …