Often, participation in the process of developing Medicaid payment policy is limited to state agency officials and providers of care and, occasionally, union representatives and state legislative staff. Invited less frequently to reimbursement policy discussions are consumer representatives. Lack of consumer involvement in the development of state rate setting systems has the potential to result in the adoption of methodologies that favor industry and government interests at the expense of issues important to residents and their families. It also has the potential to result in less creative changes to state reimbursement systems than might otherwise have been possible. All stakeholders, including consumer advocates, must be at the table if truly informed reimbursement policy reform is to take place.

New York and Minnesota are two states where policymakers have prioritized consumer involvement in the development and implementation of Medicaid nursing home reimbursement policy. This has contributed to improvements in each state’s payment system to better encourage access, care quality, and quality of life. To understand the consumer role in Medicaid nursing home reimbursement, 24 in-depth interviews were conducted with 27 individuals in these states, including state agency officials, state legislators and legislative staff, consumer advocates (including ombudsmen), union staff, and nursing home industry representatives. Pertinent documents were reviewed as well.

States also seek to align providers’ interests with those of other interested parties through controls and incentives built into state reimbursement systems, including with respect to facility cost and quality, access to care, payment equity, service capacity, and budgetary control. Prevailing lack of consumer involvement in the development and implementation of state rate setting systems has the potential to result in the adoption of methodologies that favor industry and government interests at the expense of issues important to residents and their families. All stakeholders, including consumer advocates, must be at the table if truly informed reimbursement policy reform is to take place.

New York and Minnesota are two states where consumers have been successful in influencing the development and implementation of Medicaid nursing home reimbursement policy to better encourage access, care quality, and quality of life. To understand how consumers can acquire a seat at the table and be effective in influencing Medicaid nursing home reimbursement, 24 in-depth interviews were conducted with 27 individuals in these states, including state agency officials, state legislators and legislative staff, consumer advocates (including ombudsmen), union staff, and nursing home industry representatives. Pertinent documents were reviewed as well.

Now is the time to be planning how to take advantage of several provisions within Patient Protection and Affordable Care Act (ACA) of 2010 related to provider reimbursement where implementation would benefit from consumer involvement. One example, the National Pilot Program on Payment Bundling, will combine payments for hospitals, physician, outpatient, and post-acute care into a unified payment for ten specific chronic conditions. Elsewhere in the ACA are a number of Medicare value-based purchasing/payfor-performance provisions which require the development of plans to implement valuebased purchasing for nursing homes and home health care providers as well as to pilot test pay-for-performance for other providers, including long-term care hospitals, rehabilitation hospitals and hospice. What strategies should consumers pursue to influence these and other similar endeavors?

New York and Minnesota are two states where consumers have been successful in influencing the development and implementation of Medicaid nursing home reimbursement policy to better encourage access, care quality, and quality of life. To understand how consumers can acquire a seat at the table and be effective in influencing payment policy, 24 in-depth interviews were conducted with 27 individuals in these states with known or demonstrable experience in this area. Subjects interviewed include: state agency officials, state legislators and legislative staff, consumer advocates (including ombudsmen), union staff, and nursing home industry representatives. Pertinent documents were reviewed as well. The primary purpose of this report is to detail lessons learned from New York and Minnesota about how best to promote effective consumer involvement in the reimbursement of nursing homes and other long-term care providers.

Care managers are key personnel in providing HCBS to elder clients and have unique insights regarding HCBS. This study builds on qualitative research conducted by Wong and Silverstein (2011) by further exploring the themes that emerged from the previous study related to termination triggers, gaps in HCBS, and the identification and roles of key decision makers in the termination process. In addition, this study examined risk scenarios that may trigger discharge from home- and community-based care programs into institutional settings.

The monthly pension benefit is typically based on years of service to the employer, age, and salary history. Retirees also have the option to elect a joint-and-survivor benefit, to ensure that pension payments continue to a surviving spouse. DB plan participation rates among private sector American workers have sharply decreased from about 38 in 1980 to 20 percent in 2008. DB plan coverage in the public sector has not followed this same trend. Overwhelmingly, employees of local, state or federal government are covered by a traditional pension plan. For the same time period, the percentage of private sector workers covered by a defined contribution (DC) retirement plan, such as 401(k) plans, rose from 8 to 31 percent. Under such DC plans, employers and/or employees make contributions to a retirement savings account. Employees typically need to decide how to invest these sums in order to produce accumulated savings for income at retirement.

Recent turmoil in financial markets has substantially reduced the DC plan retirement savings of many workers and retirees alike. This has heightened public concerns that many older American households will not accumulate sufficient retirement savings to meet their needs in retirement. Although investment losses certainly have adversely affected the funding of many DB plans, the predictable monthly benefits of DB plans remain a source of security to retired households who have these plans.

Client data from the Legal Advocacy and Resource Center (LARC), Greater Boston Legal Services (GBLS), and six other regional legal service programs (MetroWest Legal Services -MWLS, Massachusetts Justice Project -MJP, Merrimack Valley Legal Services - MVLS, Neighborhood Legal Services -NLS, South Coastal Counties Legal Services-SCCLS, and Western Massachusetts Legal Services-WMLS) were combined into one data file. (Data from Legal Assistance Corporation of Central Massachusetts, which services the Worcester area, were not in a readily accessible format; thus, those data are not included in the assessment.) The sample includes all cases of clients 60 years of age and older that were closed in 2010. Full service and brief service cases are included. Not included are calls that were not recorded as cases and therefore not entered into the data base. Data fields used in this report include client characteristics, presenting legal problems, length of service, and case disposition. The combined sample of cases includes 6,713 unique Massachusetts client cases.