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CMS Approves Grant for Medicaid Home- and Community-Based Care Expansion

By Nellie Bristol, CQ HealthBeat Associate Editor

March 2, 2012 -- New Hampshire will receive a federal grant for home- and community-based, long-term care under Medicaid, Centers for Medicare and Medicaid Services (CMS) officials recently announced.

It is the first state to receive such funding, which totals $26.5 million over three years and was authorized in the health care overhaul (PL 111-148, PL 111-152). The money is distributed in the form of enhanced federal matching payments under the joint federal/state program. A total of $3 billion is available to states from Oct. 1, 2011, to Sept. 30, 2015. A CMS spokesman said other states are interested in the grants and the agency is reviewing an application from Maryland.

Known as the Balancing Incentive Program, it's an effort to increase the proportion of Medicaid long-term care dollars spent on home and community-based services compared to funding for institutional care. To be eligible, a state must now spend less than 50 percent of its total Medicaid long-term care funds on community-based options. States are required to outline plans for expanding services and making structural changes to their delivery systems.

"While federal Medicaid law requires states to pay for institutional care for the elderly or persons with disabilities who may need assistance with activities of daily life, home or community-based long-terms supports are optional," CMS says in a press release. "All states, however, operate home- or community-based option programs in Medicaid but demand frequently exceeds the state's available resources."

Nancy Rollins, New Hampshire associate commissioner and director of community based care services, said in a press call this past week that the state has been expanding home and community-based options for a number of years and was "thrilled" with the grant. "We are absolutely committed to consumer directed care, offering more choices...opening up the possibility that all consumers and their care givers can have the supports they need to live in the community," she said.

In 2009, 41 percent of New Hampshire's Medicaid long-term care funding went toward home and community-based care, state officials said. They hope that in 2013, the percentage will increase to 47 percent.

Although Medicaid has an institution-based bias arising from its original 1965 long-term care coverage mandates, MaryBeth Musumeci, an analyst with the Kaiser Family Foundation Commission on Medicaid and Uninsured, said states and the federal government have been "really pushing to rebalance their spending" between home and community-based and institutional care.

Not only is community care more consumer friendly and cheaper, she said, the Supreme Court ruled in 1999 that disabled people should be allowed to remain at home or in the community if they are able and chose to do so. To further the trend, the health care overhaul included several options for states to expand access to home and community-based services under Medicaid. Nonetheless, state adoption of the new opportunities has been uneven, Musumeci said, because they are grappling with a number of new requirements under the overhaul and because of continuing uncertainty about the law's future.

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