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State Long-term Care Programs: Balancing Cost, Quality, and Access

Federal/State Partnership


Mary Jean Duckett, M.S.P., Director, Division of Benefits, Coverage, and Payment, Disabled and Elderly Health Programs Group, Center for Medicare and State Operations, Centers for Medicare & Medicaid Services (CMS), U.S. Department of Health and Human Services, Baltimore, MD.

The Medicaid program and long-term care services are indeed a partnership between Federal and State agencies. One of the shared goals of the partnership is meeting the requirements of the Americans with Disabilities Act (ADA).

Mary Jean Duckett described the implementation of Executive Order 13217 on Federal agencies that recently completed and submitted to the President a series of steps that can be undertaken to improve access to community-based services for people with disabilities.

Ms. Duckett also described grant programs to States and other organizations to expand community based services and to provide technical assistance to State and groups involved in these programs. The Centers for Medicare & Medicaid Services (CMS) is also reviewing its own policies and regulations to see where they have flexibility for States to make it easier to serve people with disabilities in the community.

For example, CMS has issued a letter to State Medicaid directors clarifying that Section 1915 (c) waivers can be amended to cover the transitional expenses incurred by people moving from a nursing home to the community after they have given up their primary residence.

Some examples of costs that in the past have posed barriers to relocation from nursing homes and may now be covered include:

  • Deposits for rent, utilities, and phone service.
  • Buying furniture or other items needed to set up an apartment.
  • Adaptations to a living unit and moving expenses.

CMS is also considering recommending legislation that allows home and community based services (HCBS) programs as a Medicaid State plan option and allowing Mental Retardation and Developmental Disabilities (MR/DD) programs to de-link institutional and waiver eligibility. In response to a question, Ms. Duckett indicated that CMS is not currently considering proposing legislation to allow Medicaid to cover room and board in residential settings.

Current as of September 2002

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Internet Citation:

State Long-term Care Programs: Balancing Cost, Quality, and Access. Workshop Brief, May 6-8, 2002. User Liaison Program. Agency for Healthcare Research and Quality, Rockville, MD.

The information on this page is archived and provided for reference purposes only.

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