Victoria Peebles

The HCBS taxonomy: a new language for classifying home- and community-based services.

INTRODUCTION As states make home- and community-based services (HCBS) more accessible, researchers have become more interested in understanding service use and spending. Because state Medicaid programs differ in the types of services they offer and in how they report these services, analyzing HCBS at the national level is challenging. OBJECTIVE Describe the HCBS taxonomy and present findings on HCBS waiver expenditures and users. DATA This brief analyzed fee-for-service claims from 28 approved states in 2010 Medicaid Analytic eXtract (MAX) files. We summed all expenditures and counted the unique number of users across each HCBS taxonomy service and category. METHODS The taxonomy was developed jointly by Truven Health (at that time Thomson Reuters) and Mathematica Policy Research, with stakeholder input, and reviewed using procedure codes. Today, the taxonomy is organized by 18 categories and over 60 specific services. FINDINGS For calendar year 2010, 28 states spent almost

CHIP and Medicaid: Evolving to Meet the Needs of Children.

23.6 billion on HCBS, with 80 percent of expenditures categorized as round-the-clock, home-based, and day services. Other services, such as case management, or equipment, modifications, and technology were widely used, but are not particularly costly and do not account for a large proportion of expenditures in every state. CONCLUSIONS By providing a common language, the taxonomy presents detailed information on services and makes it easier to assess and identify state-level variation for HCBS.

Children's Health Insurance Program: An Evaluation 1997-2010

OBJECTIVE To examine the evolution of Childrens Health Insurance Program (CHIP) and Medicaid programs after passage of the Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA), focusing on policies affecting eligibility, enrollment, renewal, benefits, access to care, cost sharing, and preparation for health care reform. METHODS Case studies were conducted in 10 states during 2012-which included key informant interviews and consumer focus groups-and a national survey of state CHIP program administrators was conducted in early 2013. RESULTS Despite the recession that persisted during much of the study period, many states expanded childrens coverage by raising upper income eligibility limits or by covering new groups made eligible by CHIPRA. Simplifying rules and procedures for enrollment and renewal continued to be a major priority for CHIP and Medicaid, and CHIPRA played a direct role in spurring innovation. CHIPRAs outreach grants played an important role in supporting and supplementing state outreach efforts. Important legacies of CHIPRA are the laws mandatory requirements for comprehensive dental benefits coverage and mental health parity for all types of CHIP programs. Although most states already offered generous coverage of these benefits, the mandate may have protected them from cuts during the economic downturn. Federal Maintenance of Effort rules were a crucial protection for CHIP, especially during the recession when state budget shortfalls could have led to program cuts. CONCLUSIONS Passage of the Affordable Care Act has raised questions surrounding the future role of CHIP in a reformed health care system. A growing number of stakeholders have recommended a 2-year extension of federal CHIP funding to allow complex transition issues to be resolved.