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The Deficit Reduction Act (DRA) of 2005, which became a law in February 2006, includes several significant changes to Medicaid long-term care policies. The Kaiser Family Foundation's Commission on Medicaid and the Uninsured has released five new reports on long-term care issues that were addressed by the DRA changes that can be found on the Web site at


Long-term care accounts for 36% of Medicaid spending (more than $100 billion annually) and is used by many of Medicaid's most costly beneficiaries, the low-income elderly, and individuals with disabilities. The new report, Medicaid Long-Term Services Reforms in the Deficit Reduction Act (Pub. no. 7486), provides an overview of the changes to the rules and direction of Medicaid long-term care services as enacted in the DRA.


Because of the concern that wealthy elderly Americans were transferring assets to gain Medicaid coverage for nursing home care, the DRA tightened Medicaid eligibility rules related to asset transfers. Approximately 43% of all nursing home residents eventually become eligible to receive Medicaid. Asset Transfer and Nursing Home Use: Empirical Evidence and Policy Significance (Pub. no. 7487) concludes that for people who become eligible for Medicaid at the time of nursing home admission, 50% had asset (cash and deed) transfers of less than $5000. Conversely, only 13% of people who became eligible for Medicaid at admission transferred more than $50000. Asset transfer patterns were most common among nursing home residents who did not receive Medicaid assistance, with more than 50% of that group making a transfer. Over the 6-year period examined, the authors estimate that when applying the DRA asset transfer rules, federal savings to Medicaid could amount to $1.87 billion.


Three other reports released today focus on the challenges and efforts of moving toward more home- and community-based Medicaid long-term care services.


* Beyond Cash and Counseling: An Inventory of Individual Budget-Based Community Long Term Care Programs (Pub. no. 7485)describes the evolution of beneficiary-managed home and community-based services since the original demonstration and provides an overview of state activity as of January 2006. The DRA gives states the option to use this model for an expanded range of home- and community-based services in their state Medicaid plans without having to obtain a waiver.


* Nursing Home Transition Programs: Perspectives of State Medicaid Officials (Pub. no. 7484) and Nursing Home Transition Programs: Perspectives of Medicaid Care Planners (Pub. no. 7483) draw on interviews with state Medicaid program officials and Medicaid care planners for insight into the issues that arise in establishing programs to move individuals with significant long-term care needs from institutional to community settings. The five states that participated in this study-Florida, Louisiana, New Jersey, Ohio, and Washington-each received federal grants for nursing home transition activities and had varied experiences.



The Kaiser Family Foundation has also posted the following new and updated educational resources on its Web site at


Medicare/Medicaid Dual Eligibles Tutorial (New)

This new narrated slide tutorial provides an overview of dual eligibles-beneficiaries covered by both Medicare and Medicaid. The tutorial presents a profile of dual eligibles; reviews the eligibility, benefits, and financing for duals; and discusses their transition into the new Medicare prescription drug coverage program.


Immigrant Health Policy Reference Library (New)

This new compendium summarizes data and research on immigrants' health coverage and access to care. The library also includes a list of organizations that conduct analysis on the impact of major health policies on immigrants and presents research on specific populations, including Latino, African, and Asian immigrants.


Health Coverage and the Uninsured Tutorial (Updated)

This tutorial by Diane Rowland of the Kaiser Family Foundation has been expanded to include the latest national and state-level data on insurance coverage rates, current policy proposals for expanding coverage to the uninsured, and criteria for evaluating the different proposals.


Directory of Health Policy Fellowships (Updated)

The directory contains new listings for undergraduates, graduate students, and professionals searching for summer, school-year, or postdoctoral positions. Recent additions include the following:


1. Harvard Medical School's Four Directions Summer Research Program


2. Lifelong AIDS Alliance: Fisher Fellowship in HIV/AIDS Policy


3. Johns Hopkins University: Postdoctoral Fellowship in Urban Health