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Medicaid Coverage of Home and Community Services: Overview 19long-term care services. It highlights Medicaid spendingon long-term care, mandated services, and eligibilityrequirements. Particular attention is paid to nursinghome care and the laws that seek to ensure quality ofcare. It may be obtained free of charge from the KaiserFamily Foundation website at www.kff.org or ordered fromtheir publications line at (800) 656-4533.www.hcfa.gov/medicaidMedicare/Medicaid (500 Sites): whatsonthe.net(click on Medicare/Medicaid under Health)Murphy's Unofficial Medicaid Page:www.geocities.com/CapitolHill/5974National Association of State Medicaid Directors:www.aphsa.org (click on Links)Burwell, B., and Crown, W. (1994). Public financing oflong-term care: Federal and state roles. Cambridge:The MEDSTAT Group. (40 pages)This paper provides an overview of public financing oflong-term care services for elderly persons throughMedicare, Medicaid, and other public programs. It presentsstatistics, characteristics of publicly-financed programs,and the variation in financing across the 50 states.It discusses utilization trends and the allocation of federaland state monies to pay for services such as homehealth and personal care. Graphs and tables enhance thepresentation. The paper also discusses cost containmentmethods employed by funding sources, quality assurancemeasures, and access to care issues. It emphasizesthe states’ primary role in shaping the publicly financedlong-term care system and the policy implications ofthat role. The paper provides a thorough understandingof the history of public funding for long-term care,financing options that states have employed, and considerationsthat must be taken into account when providinglong-term care. The paper can be obtained free ofcharge by writing to Pauline Chouinard at The MEDSTATGroup, 125 Cambridge Park Drive, Cambridge, MA 02140.WebsitesThe following websites provide some informationabout Medicaid, long-term care, or home and communityservices. This list is not inclusive of all the resourcesavailable on the internet, but provides a goodstarting point for finding information.Federal Government WebsitesAdministration on Aging: www.aoa.govAgency for Healthcare Research and Quality:www.ahrq.govAssistant Secretary for Planning & Evaluation (ASPE):aspe.hhs.govHealth Care Financing Administration (HCFA):www.hcfa.govHCFA's Medicaid information:State Government WebsitesIntergovernmental Health Policy Project:www.ncsl.orgNational Academy for State Health Policy (NASHP):www.nashp.orgNational Association of State Mental Health Directors:www.nasmhpd.orgNational Conference of State Legislatures:www.ncsl.orgState and Local Governments on the Web:www.piperinfo.com/stateFoundationsKaiser Family Foundation: www.kff.orgThe Robert Wood Johnson Foundation: www.rwjf.orgCommonwealth Fund: www.cmwf.orgAssociations and OrganizationsAmerican Association of Homes & Services forthe Aging: www.aahsa.orgAmerican Association of Retired Persons (AARP):www.aarp.orgAmerican Public Human Services Association:www.aphsa.orgBazelon Center for Mental Health Law:www.bazelon.orgConsortium for Citizens with Disabilities:www.c-c-d. orgIndependent Living Research Utilization (ILRU):www.ilru.orgLiberty Resources: www.libertyresources.orgNational Senior Citizens Law Center: www.nsclc.org
Guide to Chapter 2Overview of Medicaid Financial Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Medicaid for SSI Beneficiaries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23General Rule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Exceptions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Countable Income or Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24SSI Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Medicaid Exceptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Eligibility Expansion Options Including, but Not Specific to, Home and Community Services . . . . 25100 Percent of Poverty Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Medically Needy Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Eligibility Expansion Options That Can Be Targeted to Persons Needing Home andCommunity Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27State Supplemental Payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27300 Percent of SSI Income Rule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Miller Trusts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Protected Amounts in Calculating Post-Eligibility Share-of-Cost Obligation . . . . . . . . . . . . . . 29Spousal Impoverishment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Provisions Specific to Children with Disabilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Zebley Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Katie Beckett Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Reducing Financial Barriers to Employment for Persons with Disabilities . . . . . . . . . . . . . . . . . . . . . 33Federal Provisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33State Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Asset/Resource Transfers: Permissions and Penalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Estate Recoveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Annotated Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Page 4: Understanding MedicaidHome and Comm
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