Health: Chronic Illness, Disability and Aging

Medicaid Managed Care: Background, Issues and Options

Abstract: 

This Research & Policy brief was prepared for the Health Care Forum of the Policy Leaders Academy, a nonpartisan educational program for Maine Legislators.

The brief defines managed care, discusses state goals for and common models of managed care, and describes design decisions that state Medicaid agencies face.

Suggested citaion:

Fralich, J. T. (2011). Medicaid managed care: Background, issues, and options. Portland, ME: University of Southern Maine, Muskie School of Public Service

Publication Type: 
Research and Policy Brief
Publish Date: 
January 14, 2011
Author: 
URL: 
http://muskie.usm.maine.edu/Publications/DA/Medicaid-Managed-Care_Brief_Fralich_2011.pdf

Dementia in Maine: Characteristics, Care, and Cost Across Settings [CHARTBOOK]

Abstract: 

The World Health Organization and Alzheimer’s Disease International have recommended that dementia be considered a public health priority for all nations. The number of people with Alzheimer’s disease in Maine is expected to nearly double from about 26,000 persons in 2010 to nearly 50,000 by 2030. As the oldest state in the nation, Maine faces the impending impact of this disease on its social systems, community resources and its health and long term care systems.  In particular, service and use patterns highlighted in this report indicate that Maine’s long term care system is increasingly becoming a system of care for people with dementia.

This report provides a baseline picture of the current use of services by people with and without dementia in Maine. While this provides a comprehensive view of those accessing services through state funded home care programs or other MaineCare funded long term care services, it does not include the costs of informal care by caregivers, friends and family members. Nor does it include the out-of-pocket costs that many incur with private resources to care for a family member. We hope, however, that this information will be useful to those who are planning for the future of Maine’s long term care system and the needs of people with dementia and their families and caregivers.

Suggested Citation: Fralich J, Bratesman S, Olsen L, et al. Dementia in Maine: Characteristics, Care, and Cost Across Settings. Portland, ME: University of Southern Maine, Muskie School of Public Service; December, 2013.

For more information contact: Julie Fralich Julief@usm.maine.edu; 207-780-4848; Stuart Bratesman sbrates@usm.maine.edu; or  Louise Olsen louiseo@usm.maine.edu

This report was prepared under a Cooperative Agreement between the Muskie School of Public Service, University of Southern Maine and the Maine Department of Health and Human Services, Office of Aging and Disability Services.  This work was funded under Cooperative Agreement number CA-ES-13-251.

Publication Type: 
Report
Publish Date: 
December 31, 2013
URL: 
http://muskie.usm.maine.edu/Publications/DA/Dementia-Maine-Chartbook-2013.pdf

Older Adults and Adults With Disabilities: Population and Service Use Trends in Maine, 2012 Edition. Chartbook.

Abstract: 

This Chartbook is an update to the Chartbook: Older Adults and Adults with Physical Disabilities: Population and Service Use Trends in Maine 2010. With the aging of Maine’s population and its status as the “oldest” state in the nation, the use of long term services continues to be a critical public policy issue in the State and nationally. The information in this Chartbook is provided to help inform state policy makers, legislators, providers, advocates and others with an interest in this subject.

Outline of the Chartbook:

  • Sections 1-4 of this Chartbook provide general demographic information on historical and projected change in the population of older adults in Maine, by county and compared with other states. These sections also provide an overview of the number of older adults who live in poverty, have a disability and live in rural areas.
  • Sections 5 and 6 provide comparisons of the characteristics of people who live in nursing facilities, residential care facilities and at home.
  • Sections 7-10 examine the trends in the use and “case mix” of people in nursing facilities and residential care facilities.
  • Section 11 provides an overview of the supply of nursing and residential care facilities and beds.
  • Section 12 includes a summary of selected quality indicators across long term care settings.
  • Section 13 provides a comparison of the use of services across long term care settings and
  • Section 14 provides comparative expenditure data.

When referencing or using any of the charts or other materials in the Chartbook, please use the following recommended citation:

Fralich, J. et al., Older Adults and Adults with Disabilities: Population and Service Use Trends in Maine, 2012 Edition. (Chartbook). Portland, ME: University of Southern Maine, Muskie School of Public Service; 2012. Available at: http://muskie.usm.maine.edu/Publications/DA/Adults-Disabilities-Maine-Se...

Publication Type: 
Report
Publish Date: 
December 30, 2012
URL: 
http://muskie.usm.maine.edu/Publications/DA/Adults-Disabilities-Maine-Service-Use-Trends-chartbook-2012.pdf

Members Dually Eligible for MaineCare and Medicare Benefits: MaineCare and Medicare Expenditures and Utilization, State Fiscal Year 2010. Chartbook.

Abstract: 

This report is one of a series of reports prepared by the USM Muskie School on MaineCare members who are dually eligible for MaineCare and Medicare Services.  This first report provides a high level overview of the MaineCare and Medicare use and expenditure patterns for all members who were dually eligible in state fiscal years (SFY) 2008-2010.  This report provides baseline data on the characteristics of Medicare-MaineCare members who are dually eligible, the distribution of expenditures across categories of service for MaineCare and Medicare, and the cost of care for people with select chronic conditions. The report includes information on members considered full benefit as well as those who are partial benefit members.  Partial benefit members are also know as Qualified Medicare Beneficiaries, Specified Low Income Medicare Beneficiaries; Qualified Individuals; and Qualified Disabled and Working Individuals.  Individuals who are dually eligible for MaineCare and Medicare typically have multiple chronic conditions, high medical and long term care costs, and low income. Medicare covers hospital, medical, skilled long term care and pharmacy services while Medicaid pays for behavioral health, community based long term services and supports and nursing home services. The integration of services and benefits for people who are dually eligible is a challenge for states and the federal government. As states move to introduce value based purchasing initiatives through health homes, accountable care communities and other managed care efforts, the need to coordinate services and align incentives between the Medicaid and Medicare programs becomes increasingly critical. Many states are involved in dual eligible demonstrations to improve the integration of services, benefits and care.

Suggested Citation:

McGuire C, Gressani T, Bratesman S, Fralich J, Griffin E.  Members Dually Eligible for MaineCare and Medicare Benefits: MaineCare and Medicare Expenditures and Utilization, State Fiscal Year 2010. (Chartbook).  Portland, ME: University of Southern Maine, Muskie School of Public Service; October 2012.


Publication Type: 
Report
Publish Date: 
October 30, 2012
URL: 
http://muskie.usm.maine.edu/Publications/DA/DualEligible-Chartbook-SFY2010.pdf

Children and Adults With Long Term Services and Support Needs: MaineCare and Medicare Expenditures and Utilization, State Fiscal Year 2010. Chartbook.

Abstract: 

This report is one of a series of reports prepared by the USM Muskie School on MaineCare members who are dually eligible for MaineCare and Medicare Services. An earlier report provided a high level overview of the MaineCare and Medicare use and expenditure patterns for all members who were dually eligible in state fiscal years (SFY) 2008 to 2010. Both reports were prepared as part of the Maine State Profile Tool grant funded by the Centers for Medicare & Medicaid Services. This second report analyzes the characteristics, use and expenditure patterns of sub-populations of long term service users including adults with mental illness, adults with brain injury, adults with developmental disabilities, older adults and adults with disabilities and children with mental illness and children with developmental disabilities. The report includes information on MaineCare-only members and members who are dually eligible for MaineCare and Medicare. Dually eligible members in this report are those considered full benefit members.

Suggested Citation:

McGuire C, Bratesman S, Gressani T, Fralich J, Griffin E.  Children and Adults With Long Term Services and Support Needs: MaineCare and Medicare Expenditures and Utilization, State Fiscal Year 2010. (Chartbook).  Portland, ME: University of Southern Maine, Muskie School of Public Service; December 2012.

Publication Type: 
Report
Publish Date: 
December 1, 2012
URL: 
http://muskie.usm.maine.edu/Publications/DA/MaineCare-Medicare-analysis-Children-Adults-LTSS-SFY2010.pdf

Maine's Community Living Program: Implementation and Outcomes

Abstract: 

Over the last five years, options counseling has evolved from a general set of activities and functions within Area Agencies on Aging and Aging & Disability Resource Centers (AAAs/ADRCs) to a more standardized and generally accepted role within the Aging Network. With the award of the Community Living Program (CLP) grant in 2009, Maine proposed to develop more consistent methods for identifying people at risk of residential facility placement and to begin to develop standards for the options counseling functions. In 2010, Maine was also awarded an Options Counseling Standards Grant which has provided support for furthering the work started under the CLP grant.

Muskie School staff developed a Consumer Satisfaction Survey, A Survey of Options Counselors and Options Counselor Manager/Supervisor Survey. Results of the surveys and data from the follow-up form developed by the Steering Committee are included in the Outcomes section of this report. Muskie staff also conducted the evaluation of Maine's Options Counseling Standards Grant. The results of this evaluation are organized into two main sections: Implementation of Options Counseling which examines the processes, protocols and practices that were developed , and Outcomes which examines the implementation of the options counseling services along four dimensions:

  • Consumer Outcomes;
  • Staff Outcomes;
  • Organizational Outcomes; and
  • System Outcomes.

Suggested citation:

Fralich J, Richards M, Olsen L. Maine's Community Living Program: Implementation and Outcomes. Portland, ME: University of Southern Maine, Muskie School of Public Service; December 2011.

Publication Type: 
Report
Publish Date: 
December 30, 2011
URL: 
http://muskie.usm.maine.edu/Publications/DA/Maine-Community-Living-Program-Implementation-Outcomes.pdf

"Homelike" Characteristics of Maine's Residential Services: A Survey of Maine's Residential Service Settings (2010). Chartbook.

Abstract: 

To better understand the nature of the residential facilities serving more than 19 percent of Maine’s Long Term Services and Supports (LTSS) population, the Maine Department of Health and Human Services commissioned the Muskie School to conduct a survey of residential facilities as part of its update to Maine’s LTSS profile. The goal of the Maine Residential Settings Characteristics Survey, conducted between July and September 2010, was to measure the "homelike" characteristics of residential settings.

The survey sample comprised a total of 636 facilities which included all licensed residential care facilities or private non-medical licensed institutions. The survey response rate was 82.9%, and survey questions collected information about the facilities' physical characteristics and features, services, resident characteristics, and policies relating to autonomy and privacy.

Suggested citation:

Fralich J, McGuire C, Griffin E. "Homelike" Characteristics of Maine's Residential Services: A Survey of Maine's Residential Service Settings (2010). (Chartbook).  Portland, ME: University of Southern Maine, Muskie School of Public Service; November 2012.

Publication Type: 
Report
Publish Date: 
November 1, 2012
URL: 
http://muskie.usm.maine.edu/Publications/DA/ME-Residential-Facilities-Survey.pdf

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