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Author: Stephen Kaye Publisher: ISBN: Category : Languages : en Pages : 0
Book Description
With the population ageing, the demand for long term care (LTC), particularly services at home, is increasing. Of those individuals receiving LTC services in the US, most paid services were funded by the government. In 2006, of the total $177.6 billion in estimated spending for LTC nationally, $124.9 billion was for nursing homes (excluding hospital-based LTC) and $52.7 billion was spent on home care. Medicaid is the primary payer for LTC services for individuals with low incomes, paying for 45.8 percent of nursing home care and 37.6 percent of home health in the US in 2006. Medicaid is a joint federal and state programme, which covers individuals who are on Supplemental Security Income and those who meet each state's income and asset requirements (the categorically needy). In some states, it also pays for individuals who spend down their incomes to each state Medicaid level because of medical costs (the medically needy). The focus of this report is to examine issues of access, cost, and quality for Medicaid Home and Community-Based Services programmes. The trends in state Medicaid HCBS programmes, target groups, participants, and expenditures are summarised. The paper shows the progress in providing Medicaid HCBS but also identifies many current problems and policies. Inequities in access to services and limited funds result in unmet needs for HCBS. HCBS cost issues have been a primary focus of policy makers and quality problems are largely not addressed. Policy recommendations are made to improve access, costs and quality at the federal and state levels in the future.
Author: Stephen Kaye Publisher: ISBN: Category : Languages : en Pages : 0
Book Description
With the population ageing, the demand for long term care (LTC), particularly services at home, is increasing. Of those individuals receiving LTC services in the US, most paid services were funded by the government. In 2006, of the total $177.6 billion in estimated spending for LTC nationally, $124.9 billion was for nursing homes (excluding hospital-based LTC) and $52.7 billion was spent on home care. Medicaid is the primary payer for LTC services for individuals with low incomes, paying for 45.8 percent of nursing home care and 37.6 percent of home health in the US in 2006. Medicaid is a joint federal and state programme, which covers individuals who are on Supplemental Security Income and those who meet each state's income and asset requirements (the categorically needy). In some states, it also pays for individuals who spend down their incomes to each state Medicaid level because of medical costs (the medically needy). The focus of this report is to examine issues of access, cost, and quality for Medicaid Home and Community-Based Services programmes. The trends in state Medicaid HCBS programmes, target groups, participants, and expenditures are summarised. The paper shows the progress in providing Medicaid HCBS but also identifies many current problems and policies. Inequities in access to services and limited funds result in unmet needs for HCBS. HCBS cost issues have been a primary focus of policy makers and quality problems are largely not addressed. Policy recommendations are made to improve access, costs and quality at the federal and state levels in the future.
Author: Alan Weil Publisher: The Urban Insitute ISBN: 9780877667162 Category : Business & Economics Languages : en Pages : 448
Book Description
The balance between state and federal health care financing for low-income people has been a matter of considerable debate for the last 40 years. Some argue for a greater federal role, others for more devolution of responsibility to the states. Medicaid, the backbone of the system, has been plagued by an array of problems that have made it unpopular and difficult to use to extend health care coverage. In recent years, waivers have given the states the flexibility to change many features of their Medicaid programs; moreover, the states have considerable flexibility to in establishing State Children's Health Insurance Programs. This book examines the record on the changing health safety net. How well have states done in providing acute and long-term care services to low-income populations? How have they responded to financial incentives and federal regulatory requirements? How innovative have they been? Contributing authors include Donald J. Boyd, Randall R. Bovbjerg, Teresa A. Coughlin, Ian Hill, Michael Housman, Robert E. Hurley, Marilyn Moon, Mary Beth Pohl, Jane Tilly, and Stephen Zuckerman.
Author: National Academies of Sciences, Engineering, and Medicine Publisher: National Academies Press ISBN: 030946921X Category : Medical Languages : en Pages : 161
Book Description
The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
Author: Genevieve Graaf Publisher: ISBN: Category : Languages : en Pages : 123
Book Description
It is estimated that approximately 8 to12% of all youth can be classified as severely emotionally disturbed (SED) (Costello, Egger, & Angold, 2005; Kessler et al., 2012). These youth exhibit a wide range of mental health disorders and symptoms (e.g., depression, anxiety, difficulty with emotion regulation or executive functioning) (Costello et al., 2005), and the extent to which to which their functioning is impaired by these symptoms and challenges varies widely (Williams, Scott, & Aarons, 2017). Only 25% of any of these children and adolescents ever access any outpatient mental health treatment (Costello et al., 2005; Costello, Messer, Bird, Cohen, & Reinherz, 1998) and even fewer obtain the intensive Home and Community-Based Services (HCBS) needed to keep youth with the most significant impairments safely in their home and communities (Owens et al., 2002; Spiker, 2017). Home and Community-Based Services (HCBS) often include in-home therapy, case management, or therapeutic behavioral support services (Kernan, Griswold, & Wagner, 2003; Marcenko, Keller, & Delaney, 2001). Without HCBS, youth with the most significant behavioral healthcare needs are at greater risk for chronic or long-term placement in a residential setting in either a psychiatric, correctional, or foster placement (Hansen, Litzelman, Marsh, & Milspaw, 2004; Knitzer & Olson, 1982; Narrow et al., 1998). Many families cite expense and lack of sufficient health coverage as barriers to service use (Owens et al., 2002; Spiker, 2017). The only type of health coverage that routinely covers HCBS is Medicaid (Howell, 2004), leaving these services mostly inaccessible to families whose incomes are above the Medicaid means-test limits. In order to access public health insurance to fund the intensive mental health care needed for their child, many parents relinquish custody to the state—either through the child welfare or juvenile justice system (U.S. Government Accountability Office, 2003). States use a variety of policy interventions to reduce income barriers to HCBS for these youth, including Medicaid waivers, the TEFRA provision, and State Plan Amendments (Friesen, Giliberti, Katz-Leavy, Osher, & Pullmann, 2003; Ireys, Pires, & Lee, 2006). However, little is known about these strategies or state motivations for choosing one policy over another. Limited evaluation also exists regarding their relative effectiveness at meeting the needs of these youth and their families. Having knowledge of the variety of policy tools available to states and how states utilize these tools, as well as the factors that increase the likelihood that a state will opt to use a particular tool, will allow future research to control for such variables, and better discern the effects of the policy on state level mental health system outcomes. This two-part mixed methods study aims to discern state policies that are more and less effective at reducing access barriers to home and community-based mental health care for non-Medicaid eligible youth with SED. The first, qualitative portion of the study aims to 1) identify policy mechanisms utilized by states to deliver HCBS to youth with SED and their families, particularly for youth whose family income disqualifies them for Medicaid and 2) understand what motivates State Mental Health Authorities and Medicaid Agencies to utilize current policy tools and structures for HCBS delivery for both Medicaid and non-Medicaid eligible youth with SED. The second, quantitative analysis seeks to 1) assess the relationship between a state’s use of a Medicaid waiver and the odds that a youth with SED will have public health coverage, 2) assess the relationship between public health coverage and unmet mental health care needs and cost barriers to care for youth with SED, and 3) assess the direct relationship between a youth’s residence in a state with a Medicaid waiver, and the odds that the youth will have unmet mental health care needs and cost barriers to care. Part I of this study gathered qualitative data through semi-structured interviews with officials from 32 state mental health systems about policy tactics for funding and delivering HCBS to Medicaid and non-Medicaid eligible youth with SED in their state. Interviews also gathered information about each state administration’s motivation and history that shaped the use of current HCBS policies for this population. Part II of the study utilized data created from information and observations in Part I in conjunction with data from the National Survey for Children with Special Health Care Needs from 2009/2010. Multi-level, random-intercept logistic regression models assessed the relationship between Medicaid waivers and unmet mental health care needs and cost barriers to treatment for youth with SED. Results indicate that states use many strategies for funding and organizing care for the non-Medicaid eligible population of youth with SED, but that strategies generally involve the allocation of state general revenue funds or the use of a policy that expands the financial eligibility limits of Medicaid for children. Reasons for the use of each approach are most related to the size and flexibility of Medicaid budgets, political prioritization of children and families, and political ideology related to the role of the state in providing for the welfare of children and families. The quantitative analysis found that policies expanding financial eligibility for Medicaid were related to reductions in cost-related barriers to treatment, even controlling for the mediating effect of these policies in changing the insurance status of children. However, the use of these policies and a child's coverage under public health insurance was not significantly predictive of reduced odds of having unmet mental health care needs. By controlling for the severity of a child's mental health care needs, and the interaction between their level of need and type of health insurance coverage, this analysis also highlighted the role of clinical severity in unmet treatment needs and barriers to care and the ways in which public insurance moderated this relationship. This study concludes that, though states have many means of funding care for non-Medicaid eligible youth with complex behavioral healthcare needs and have various reasons specific to state environments for choosing a particular approach, states with policies that allow children to more easily access Medicaid appear to have fewer families experiencing cost barriers to mental health services. However, these state policies do not address other, unknown barriers to obtaining mental health services for families in their states. Expansion of Medicaid eligibility for children can help to reduce unmet need due to financial obstacles but does not solve all problems related to service accessibility. Additional barriers to treatment access must be identified at the individual, organizational and policy levels for children with all levels of clinical need. Policies and practices aimed at reducing these must be identified and implemented in the manner most suitable and applicable to the unique political, fiscal, and structural concerns of each state and community. Then, these practices and policies must be rigorously evaluated for effectiveness in achieving equitable access to high quality and effective mental health treatment for all children with behavioral health concerns.
Author: Institute of Medicine Publisher: National Academies Press ISBN: 0309047420 Category : Medical Languages : en Pages : 240
Book Description
Americans are accustomed to anecdotal evidence of the health care crisis. Yet, personal or local stories do not provide a comprehensive nationwide picture of our access to health care. Now, this book offers the long-awaited health equivalent of national economic indicators. This useful volume defines a set of national objectives and identifies indicatorsâ€"measures of utilization and outcomeâ€"that can "sense" when and where problems occur in accessing specific health care services. Using the indicators, the committee presents significant conclusions about the situation today, examining the relationships between access to care and factors such as income, race, ethnic origin, and location. The committee offers recommendations to federal, state, and local agencies for improving data collection and monitoring. This highly readable and well-organized volume will be essential for policymakers, public health officials, insurance companies, hospitals, physicians and nurses, and interested individuals.
Author: Institute of Medicine Publisher: National Academies Press ISBN: 0309104726 Category : Medical Languages : en Pages : 619
Book Description
The future of disability in America will depend on how well the U.S. prepares for and manages the demographic, fiscal, and technological developments that will unfold during the next two to three decades. Building upon two prior studies from the Institute of Medicine (the 1991 Institute of Medicine's report Disability in America and the 1997 report Enabling America), The Future of Disability in America examines both progress and concerns about continuing barriers that limit the independence, productivity, and participation in community life of people with disabilities. This book offers a comprehensive look at a wide range of issues, including the prevalence of disability across the lifespan; disability trends the role of assistive technology; barriers posed by health care and other facilities with inaccessible buildings, equipment, and information formats; the needs of young people moving from pediatric to adult health care and of adults experiencing premature aging and secondary health problems; selected issues in health care financing (e.g., risk adjusting payments to health plans, coverage of assistive technology); and the organizing and financing of disability-related research. The Future of Disability in America is an assessment of both principles and scientific evidence for disability policies and services. This book's recommendations propose steps to eliminate barriers and strengthen the evidence base for future public and private actions to reduce the impact of disability on individuals, families, and society.
Author: Institute of Medicine Publisher: National Academies Press ISBN: 0309133181 Category : Medical Languages : en Pages : 536
Book Description
The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.
Author: Leiyu Shi Publisher: Jones & Bartlett Publishers ISBN: 1449626513 Category : Business & Economics Languages : en Pages : 661
Book Description
Given the recent and rapid developments in the delivery of health care in the United States, never has it been more important to have the most up-to-date resources for teaching students about this complex and dynamic industry. Now in its Fifth Edition, Delivering Health Care in America offers the most current and comprehensive overview of the basic structures and operations of the U.S. health system--from its historical origins and resources, to its individual services, cost, and quality. Using a unique systems approach, this bestselling text brings together an extraordinary breadth of information into a highly accessible, easy-to-read resource that clarifies the complexities of health care organization and finance, while presenting a solid overview of how the various components fit together. New to this Edition: New material on U.S. health reform New material on health reform in other countries New material on Healthy People 2020 New information on CMS s innovative healthcare delivery New information on community health centers Introduction of the medical home concept Data update throughout the book Latest research findings as applicable Enhanced content on The Patient Protection and Affordability Act of 2010 Enhanced content on clinical guidelines Enhanced content on public health system and services Enhanced content on vulnerable populations Enhanced content on primary care from the Global Perspective Revised perspectives on the future of health care in America Instructor Resources: Transition Guide, Instructor's Manual, PowerPoint Presentations, TestBank Student Resources: Glossary, Flash Cards, Crosswords, Matching Questions, Web Links"
Author: Tamara Thompson Publisher: Greenhaven Publishing LLC ISBN: 0737771496 Category : Young Adult Nonfiction Languages : en Pages : 130
Book Description
The Patient Protection and Affordable Care Act (ACA) was designed to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage, and reduce the costs of healthcare overall. Along with sweeping change came sweeping criticisms and issues. This book explores the pros and cons of the Affordable Care Act, and explains who benefits from the ACA. Readers will learn how the economy is affected by the ACA, and the impact of the ACA rollout.
Author: Stephen Kaye
Author: Stephen Kaye
Author: Alan Weil
Author: National Academies of Sciences, Engineering, and Medicine
Author: Genevieve Graaf
Author: Institute of Medicine
Author: Institute of Medicine
Author: Institute of Medicine
Author: Leiyu Shi
Author: Tamara Thompson
Author: United States. Social and Rehabilitation Service