Cost-efficiency in Medicaid long-term support services: the role of home and community based services

Financial Integration Scenario for Community Integrated Care: Focusing on the Case of Korea

This study analyzes the potential effects of a reform based on community integrated care in Korea, which is experiencing a high rate of population aging, and a specific method for financial integration. We first analyze the size and trend of funds used for the care for the elderly out of Korea’s health insurance, long-term care insurance, and national budget. We then analyze the amount of financial resources required and the cost-saving effect when the related financial resources are converted into local community care funds. This approach sheds light on the possibility of harmonizing healthcare policy for the elderly and integrated care under the existing insurance system and suggests a direction for reform in policies pertaining to healthcare for the elderly. Given that the same services are provided, we find that combining the finances from the insurance and the national budget would result in a fund of KRW 2.6 trillion to KRW 4.7 trillion. This approach also confirms that health care costs for the elderly can be reduced by 1-5% in the long term, which we estimate to be between KRW 1 trillion to KRW 4 trillion by 2050. We find that by tapping into the national budget to manage the pre-medical stage care, we can utilize an efficient operation mechanism unlike insurance. We also confirm that information exchange and harmonious operation between the national budget and state-run insurance as well as feedback and incentives through performance management are necessary for these results to become a reality.

“So Glad to Be Home”: Money Follows the Person Participants’ Experiences After Transitioning Out of an Institution

This study examined qualitative data from participants who transitioned from institutional to community living through the Money Follows the Person (MFP) Rebalancing Demonstration in Connecticut. As part of the MFP quality of life survey, 1,566 participants provided qualitative feedback about their experiences at 6-, 12-, and 24-month time points after transition. Maslow’s Hierarchy of Needs serves as a thematic framework to analyze the data. In their open-ended comments, many participants underscored the efficacy of the program and offered constructive feedback; some people also reported barriers and challenges to community living. While MFP participants generally report high satisfaction with the program, both in Connecticut and nationally, some participants identified areas of unmet need, including housing, transportation, and workforce issues. Findings have the potential to expand stakeholders’ understanding of participants’ needs and facilitate policies to improve services and supports for older adults and people living with disabilities who return to community living following institutionalization.

Availability of Medicaid home- and community-based services for older Americans and people with physical disabilities

This article provides an overview of Medicaid home- and community-based services (HCBS) for older adults and individuals with physical disabilities by describing eligibility criteria, availability, and types of services. All 50 state Medicaid programs provide supplementary HCBS in addition to mandatory services. The amount, type, and eligibility for HCBS varied widely between states. Variation in service provision and eligibility rules has led to a patchwork of services from state to state, with the same person eligible for services in one state but not another.

Applying User-Centered Design to Develop an Audit and Feedback Intervention for the Home Care Sector

The objective of this study was to optimize a planned audit and feedback (A&F) intervention for home and community care through incorporating user-centered design principles. Phase 1 comprised the development of a paper prototype, followed by testing of the prototype using semistructured interviews and focus groups. Phase 2 involved the development of a revised and online prototype based on the results of Phase 1, followed by user testing. A total of 39 participants across Phase 1 ( n = 33) and Phase 2 ( n = 6) provided input into the design of the A&F intervention. Key changes included improving clarity of the variables, reducing cognitive load, and highlighting opportunities for action. Preliminary findings suggest potential usefulness in this approach to optimize home care management.