Specialized Information for:

Nursing HomesAssisted Living/Board & Care Home and Community Based Services
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Medicare and Medicaid

Medicare and Medicaid are two federal programs administered by the Centers for Medicare and Medicaid Services (CMS) that provide medical and health-related services to specific populations within the United States.

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.  Medicaid provides coverage for people with lower incomes, older people, people with disabilities, and some families and children.

Medicare Resources


Medicare Changes for Transgender Older Adults Fact Sheet (October 2016)

Marriage, Medicare, and Medicaid: What Same-Sex Couples Need to Know Fact Sheet (October 2016)

Accessing Information on Medicare Benefits for LGBT People (October 2016)

10 FAQs: Medicare's Role in End-of-Life Care - (December 2015)

Created by the Henry J. Kaiser Family Foundation. This FAQ sheet can help better understand the largest insurer of health care provided during the last year of life. This information will help explain the coverage that is offered, changes to be made in the future, and cost. In addition, these FAQs describe recent relevant rules released by the Administration and additional proposals from Congress regarding advance care planning and care for people with serious and terminal illness. 

Medicare Interactive - Created by the Medicare Rights Center, Medicare Interactive can help find answers about Medicare benefits.

Medicare Prospective Payment in SNFs and its Impact on Nursing Home Residents: Questions for Ombudsmen Considering the Care of Medicare Patients in Nursing Homes (2001)

This paper reviews what is known about the Prospective Payment System's incentives for nursing homes to admit – or refuse – Medicare patients, and to provide too little – or too much – care. This information will help ombudsmen understand the Prospective Payment System and its impact on Medicare beneficiaries’ ability to get the services they need under Medicare.

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Medicaid Resources


Medicaid Bed Hold Policies by State (October 2012)

Bedhold for Nursing Home Residents: Know the Facts (September 2012)

Medicaid and Long-Term Care (Bradley Gellar 2011)

This pamphlet contains questions and answers, copies of forms to help consumers know what to expect when it comes to Medicaid and Long-Term Care and lists of agencies to contact.

Fact Sheet: Medicaid Therapeutic Leave (March 2011)

This factsheet produced by the National Long-Term Care Ombudsman Resource Center answers the following questions: Can residents receiving medicaid leave their nursing home for overnight visits?; What is a bed-hold policy?; and How can I get information about a nursing home’s bed-hold policy?

A Reporter’s Toolkit: Medicaid (November 2007)

This toolkit will help you understand who the Medicaid program covers, how it is financed, how it differs from Medicare, how states can alter Medicaid through federal waivers, and what the future holds for the program. This resource also offers story ideas, selected experts with contact information, selected websites and a glossary.

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Managed Long-Term Services and Supports


Medicaid Managed Care 101 for Ombudsman Programs

On January 11, 2017, the National Association of States United for Aging and Disabilities (NASUAD) hosted a webinar on Medicaid managed care for State Ombudsmen and Ombudsman program representatives. This webinar covered basic information about the current status and future directions of state Medicaid Managed LTSS programs; key policy and operational considerations for professionals working with older adults enrolled in these programs; and future directions for these programs. The webinar was presented by Damon Terzaghi, NASUAD’s Senior Director for Medicaid Policy and Planning. Visit the NASUAD website for more information and use the links below to access the slides, recording, and transcript.

Advocacy Strategies Through Managed Care (November 2015) 

  • PowerPoint Presentation
    • Presented by: Heather Bruemmer, State LTC Ombudsman, Wisconsin; Gwen Orlowski, J.D. Legal Services of New Jersey

Duals Demonstration Projects (November 2014)

Support for Demonstration Ombudsman Programs Serving Beneficiaries of Financial Alignment Models for Medicare-Medicaid Enrollees (November 2013)

This webinar presented by the Administration on Aging provides an outline of the funding opportunity announcement for demonstration ombudsman programs to help States and other stakeholders better understand the goals as well as requirements under this opportunity.  The webinar also discussed examples of successfully funded proposals, and provided opportunity for States and other stakeholders involved in designing and implementing other integrated care models to learn about these ombudsman programs and why they are important for any integrated model to support and protect beneficiaries that will be served by these programs.

Webinar Materials:

Managed Long-Term Services & Supports: What Does it Really Mean for Consumers? (October 2013)

This session at the 37th annual Consumer Voice conference talks about how states are jumping headfirst into contracting with managed care companies to provide long-term services and supports. But what does this mean for consumer choice, protections, quality and coordination of services, and cost? Get a national perspective and hear about the trends in states’ plans and what these managed care contracts mean for quality and evaluation of care and services. Engage in dialogue around how consumers and their advocates can impact plan development and implementation in their states and at the national level.

Session Materials:

State Dual integration Projects—What’s Going On? (October 2013)

This session at the 37th annual Consumer Voice conference talks about how states are implementing their Dual Integration Projects. Hear an overview of the different components of the project including implementation and oversight, the three-way contracts and MOUs, and opportunities for consumer involvement and advocacy. You will also hear how one state long-term care ombudsman program has been written into the dual demonstration project to fulfill the required ombudsman role.

Session Materials:

Information to Share with Consumers


Medicare Changes for Transgender Older Adults

Marriage, Medicare, and Medicaid: What Same-Sex Couples Need to Know

Accessing Information on Medicare Benefits for LGBT People

10 FAQs: Medicare’s Role in End-of-Life Care

Medicare Interactive

Medicaid Bed Hold Policies by State

Bedhold for Nursing Home Residents: Know the Facts

Medicaid and Long-Term Care

Factsheet: Medicaid Therapeutic Leave

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