Specialized Information for:
Nursing HomesAssisted Living/Board & Care Home and Community Based ServicesMedicare 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.
Jimmo Settlement Agreement Webpage (August 2017)
CMS has launched a new webpage on the Jimmo Settlement Agreement. The Jimmo Settlement agreement clarified that the Medicare program covers skilled nursing care and skilled therapy services when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline. Specifically, the Jimmo Settlement required manual revisions to restate a "maintenance coverage standard" for both skilled nursing and therapy services. The Jimmo Settlement may reflect a change in practice for those providers or others who have erroneously believed that the Medicare program covers nursing and therapy services only when a beneficiary is expected to improve. The new Jimmo Settlement Webpage provides background on the settlement, links to resources and Frequently Asked Questions.
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.
Fact Sheet: Medicaid Therapeutic Leave (March 2011)
This factsheet produced by the National Long-Term Care Ombudsman Resource Center answers the following questions:
Medicaid Bed Hold Policies by State (October 2012)
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. Visit the NASUAD website for more information and use the links below to access the slides, recording, and transcript.
Medicaid 201: Managed Long-Term Services and Supports (MLTSS) for State Ombudsmen and Program Representatives
The National Association of States United for Aging and Disabilities (NASUAD) hosted a webinar on Medicaid managed long-term services and supports (MLTSS) and the new Federal requirements for states to offer ombudsman services to managed care enrollees. Building on the groundwork laid in the January 2017, this webinar provided an overview of Medicaid managed long-term services and support (MLTSS) programs across the country; explained the new Federal requirements for MLTSS programs to offer managed care ombudsman services to enrollees; discussed opportunities and challenges of operating a managed care ombudsman program within a State LCTO office; and highlighted the work of the Iowa SLTCO in managing both a State Long-term Care Ombudsman Program and a managed care ombudsman program.
Advocates’ Guide to Accessibility in Medicaid Managed Care Grievances and Appeals (June 2018)
As states begin to incorporate new federal regulations into their Medicaid rules, there’s opportunity for advocates to help shape those rules to ensure that older adults and people with disabilities have equal access to the grievance and appeal and state fair hearing systems, as mandated by Section 504 of the Rehabilitation Act (“Rehab Act”), the Americans with Disabilities Act (“ADA”), and Section 1557 of the Affordable Care Act (“ACA”). This Advocates Guide to Accessibility in Medicaid Managed Care Grievances, Appeals, and State Fair Hearing, provides guidance on how the federal framework can be made fully accessible to Medicaid beneficiaries who are older and/or have disabilities.
Advocacy Strategies Through Managed Care (November 2015)
Duals Demonstration Projects (November 2014)
The Personal Needs Allowance is the monthly sum of money that residents who receive Medicaid may retain from their personal income. Any income above the allowance is applied toward the cost of their care. This allowance is intended for residents to spend at their discretion on items such as telephone expenses, cigarettes, a meal out with friends, cards to send to family, reading materials, or hobbies. Federal regulations prohibit long-term care facilities from charging residents’ PNA for services that are included in Medicaid payments such as toothpaste, tissues, shampoo, and incontinence products,
among others.
Nursing Home Personal Needs Allowance (PNA) by Year (2010)
QIO Program: Beneficiary and Family Centered Care – Quality Improvement Organizations
Newsletter Insert
Information about the Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) Program for your newsletter
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
Factsheet: Medicaid Therapeutic Leave