View Research by Author - Alison Evans Cuellar

Citation URL: http://www.urban.org/AlisonEvansCuellar

A major innovation in long-term care for elderly persons in the United States and Europe is the development of consumer-directed home care. These governmental programs give consumers, rather than home care agencies, control over who provides services and how these services are delivered. Typically, consumer-directed programs allow the consumer to hire, train, supervise, and fire the home care worker. In some programs, beneficiaries receive cash payments enabling them to purchase the services they want. In contrast, traditional home care programs rely on public or private agencies to supply and supervise the workers who serve program beneficiaries.

In 1994 Germany enacted a universal coverage social insurance program for long-term care to largely replace its means-tested system. The program has achieved many of its stated policy goals: shifting the financial burden of long-term care off the states and municipalities; expanding home and community-based services; lessening dependence on means-tested welfare; and increasing support of informal caregivers. These goals were reached without exploding caseloads or uncontrolled expenditures. (Health Affairs 2000 May/June; 19(3); 8-25).

Increases in managed care and competition have undercut hospitals' ability to provide care to uninsured Americans. Massachusetts, New Jersey, and New York use uncompensated care pools to spread the financial burden of providing charity care across hospitals. This paper finds that over time these states have narrowed pool coverage from all uncompensated care to indigent charity care only, have broadened pools' revenue base from hospital assessments to include other revenues, and have begun seeking ways to replace hospital care with more efficient ambulatory services. While pools do not rival comprehensive insurance coverage in funding full access to health care, the authors conclude that they are an affordable mechanism to fund improved safety-net access.

In the late 1980s, the United States, the United Kingdom and Germany had roughly the same system of financing and delivering long-term care. In contrast to the United States, the United Kingdom and Germany enacted radical reform. The United Kingdom converted an open-ended, means-tested national entitlement for institutional care to a block grant to local governments, whereas Germany enacted a nationally uniform, non-means-tested social insurance program. This article analyzes the post-reform experience of the United Kingdom and Germany with respect to issues of financing, assessment and case management, and the availability of home and community-based services. Policy implications for the United States are developed. (Journal of Aging and Health 1999 August; 11(3): 417-444).

The state reports describe the safety net and health care programs in place for low-income people on the eve of welfare reform. The reports also analyze the particular circumstances that are shaping the state's response to the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). The state reports are based on case studies in the respective state.

The state reports describe the safety net and health care programs in place for low-income people on the eve of welfare reform. The reports also analyze the particular circumstances that are shaping the state's response to the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). The state reports are based on case studies in the respective state.

The state reports describe the safety net and health care programs in place for low-income people on the eve of welfare reform. The reports also analyze the particular circumstances that are shaping the state's response to the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). The state reports are based on case studies in the respective state.

The state reports describe the safety net and health care programs in place for low-income people on the eve of welfare reform. The reports also analyze the particular circumstances that are shaping the state's response to the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). The state reports are based on case studies in the respective state.

Forty-nine states now rely on some form of Medicaid managed care plan. This brief examines several critical questions states must answer as they design Medicaid managed care programs aimed at reducing costs and increasing access to care. Who should be required to enroll in managed care? What services should Medicaid managed care plans be required to provide? How will managed care plans be paid? How will the enrollment process work?

Return to list of authors