reforming state long-term care services and supports through participant direction nashp state...
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Reforming State Long-Term Care Services and Supports Through Participant Direction
NASHP State Health Policy ConferenceOctober 2010
Suzanne CrispDirector of Program Design and
ImplementationNRCPDS
Changes in Federal Law, Regulation, and Policy
2008 Veterans-Directed Home and Community -Based Care
Program
2001 New Freedom Initiative
2006 Deficit Reduction Act
2006 Reauthorization of Older Americans Act
2007 Aging and Disability Resource Center Program
2008 Community Living Program
2
WAAK
Hawaii
OR
CA
NV
ID
MT
WY
UT
AZ
CO
NM
TX
OK
KS
NE
SD
ND MN
IA
MO
AR
LA
MS
TN
KY
IL
WI
MI
INWV
AL GA
FL
SC
NC
VA
PA
NY
DC
MD
DE
NJ
RI
MA
NH
VT
ME
OH
CT
Prevalence of Participant Direction: 1970’s
3
WAAK
Hawaii
OR
CA
NV
ID
MT
WY
UT
AZ
CO
NM
TX
OK
KS
NE
SD
ND MN
IA
MO
AR
LA
MS
TN
KY
IL
WI
MI
INWV
AL GA
FL
SC
NC
VA
PA
NY
DC
MD
DE
NJ
RI
MA
NH
VT
ME
OH
CT
4
Prevalence of Participant Direction: 1980’s
WAAK
Hawaii
OR
CA
NV
ID
MT
WY
UT
AZ
CO
NM
TX
OK
KS
NE
SD
ND MN
IA
MO
AR
LA
MS
TN
KY
IL
WI
MI
INWV
AL GA
FL
SC
NC
VA
PA
NY
DC
MD
DE
NJ
RI
MA
NH
VT
ME
OH
CT
5
Prevalence of Participant Direction: 1990’s
WAAK
Hawaii
OR
CA
NV
ID
MT
WY
UT
AZ
CO
NM
TX
OK
KS
NE
SD
ND MN
IA
MO
AR
LA
MS
TN
KY
IL
WI
MI
INWV
AL GA
FL
SC
NC
VA
PA
NY
DC
MD
DE
NJ
RI
MA
NH
VT
ME
OH
CT
6
Prevalence of Participant Direction: 2000’s
Participant Direction Survey Methods Three Part Data Collection
Secondary review of existing program information State websites Medicaid waiver applications
Brief survey on program characteristics Confirm fields of information found in secondary
review Obtain information on program population,
structure, eligibility requirements, programmatic restrictions
Brief interview on program procedures Participant engagement, FMS, worker registries,
and budget authority (if applicable)
(Very) Preliminary Findings 300 programs identified with some
level of participant direction Does not include VD-HCBS programs Possible this number will drop as survey
information is analyzed Majority are serving non-elder
population Majority are Agency with Choice
models of participant direction
9
Growth of Budget Authority ProgramsWA
AK
Hawaii
OR
CA
NV
ID
MT
WY
UT
AZ
CO
NM
TX
OK
KS
NE
SD
ND MN
IA
MO
AR
LA
MS
TN
KY
IL
WI
MI
INWV
AL GA
FL
SC
NC
VA
PA
NY
DC
MD
DE
NJ
RI
MA
NH
VT
ME
OH
CT
15 Cash & Counseling States
16 Additional States with Budget Authority Programs
10
Growth of VD-HCBS Program WA
AK
Hawaii
OR
CA
NV
ID
MT
WY
UT
AZ
CO
NM
TX
OK
KS
NE
SD
ND MN
IA
MO
AR
LA
MS
TN
KY
IL
WI
MI
INWV
AL GA
FL
SC
NC
VA
PA
NY
DC
MD
DE
NJ
RI
MA
NH
VT
ME
OH
CT
2008 – 7 States
2009 – Grew by 3 states for a total of 10
2010 – Expect to grow by 18 states for a total of 28