Options to Increase Access to Long-Term Care: Maryland House Bill 594 Final Report


This study, in response to the mandate of Maryland House Bill 594, analyzes Maryland’s options to increase access to long-term services, including home- and community-based services (HCBSs) such as adult medical day care, for individuals at high risk of institutionalization because of cognitive impairments, mental illness, traumatic brain injury, or other conditions, who met financial eligibility criteria in effect as of June 1, 2007. Three approaches to expand access to Medicaid HCBS were considered: Maryland could lower its nursing facility (NF) level of care (LOC) criteria to ease entry into both NFs and community-based programs; Maryland could leave its NF LOC at its current standard, but expand access to HCBS by providing enough funds to move people from the registries for the Older Adult Waiver (OAW) and Living at Home (LAH) waiver into services; or Maryland could adopt the new authority, included in the recently enacted federal Deficit Reduction Act (DRA), to create a service package of HCBS without the need for a waiver. The Hilltop Institute (as the Center for Health Program Development and Management) reviewed Maryland and seven other states and the District of Columbia, analyzed the estimated costs and effects of three approaches mentioned above, and analyzed the potential for long-term savings for a state, should it elect to lower its NF LOC.

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