TABLE 3-2 Appropriations History of Medicare Research, Demonstration, and Evaluation as Compared to Medicare Operations

Fiscal Year

Research, Demonstration, and Evaluation (in Millions)

Total Medicare Operations (in Millions)

Research, Demonstration, and Evaluation as Percent of Medicare Operations

2003

$73.7

$1,666.7

4.42%

2004

$77.8

$1,701.0

4.57%

2005

$77.5

$1,730.9

4.48%

2006

$69.4a

$2,200.8b

3.15%

2007

$41.5

$2,210.6c

1.88%

2008d

$33.7

$2,303.6

1.46%

aIncludes Deficit Reduction Act funding.

bIncludes Deficit Reduction Act and the Secretary’s Section 202 Transfer Authority funding.

cIncludes Tax Relief and Health Care Act of 2006 funding.

d2008 reflects the President’s FY 2008 budget.

SOURCE: DHHS, 2007.

Maine, for example, Medicaid beneficiaries are referred to a consumer-run independent living center, which assesses their preferences and their ability to self-direct care, trains them with regard to hiring and managing their own services, and provides a list of available workers (Benjamin, 2001). Oregon’s Medicaid program allows individuals, with guidance from case managers, to hire and fire workers as they choose. An evaluation of these models found that patients had greater satisfaction with services, increased feelings of empowerment, and better perceived quality of life (Stone, 2000). There is limited evidence, however, that focuses specifically on older adults and the effect that these programs have on them. Four of these programs are described below.

Arizona Long-Term Care System (Arizona)

The Arizona Long-Term Care System (ALTCS) was developed in 1989 to provide care to Medicaid-eligible individuals who are at risk of institutionalization in a long-term care setting, typically older adults and disabled persons. ALTCS is a capitated, mandatory long-term care system in which services are integrated by a managed care organization into a single delivery package. For those beneficiaries also eligible for Medicare, providers must bill those services to Medicare and are paid through the FFS system. Services offered under ALTCS include acute medical care, behavioral health services, and case management. Services are also covered for care delivered in nursing homes, in the home setting, and in assisted-living facilities.



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