Spring 2005 Course Description

Policy Research Project

Section Title: Disability and Social Policy
Instructor(s): Jacqueline Angel
Course: P A 882B - Policy Research Project
Unique Number: 62630
Day & Time: Tuesdays, 1:00 PM - 5:00 PM
Room: SRH 3.103
Waitlist Information:For LBJ Students: UT Waitlist Information

Description: The purpose of this project, sponsored by the Congressional Research Service (CRS), is to examine various facets of eligibility for long-term care and disability programs. This will include a review of national surveys on the characteristics of persons who need long-term care, state eligibility for long-term care services, and definitions of long-term care and disability criteria in federal statutes.

Background: The need for long-term care is expected to grow substantially in the future, straining both public and private resources. Total spending on long-term care services for people of all ages was over $151 billion in FY2001, with over 48% paid by Medicaid and about 22% paid out-of-pocket by recipients of long-term care and their families. The remaining amount is spent by Medicare and through private long-term care insurance. This amount does not include the substantial amount of informal care provided by family and friends. Steady expansion of public support and private financing is expected in the future to meet the needs of the growing elderly population, expected to double by 2030.

Congress has been interested in reviewing current federal policy on long-term care for some time; however, it has not yet reached a consensus on how to amend current law or propose new directions for long-term care policy. The complexity inherent in public long-term care policy is substantial. The long-term care system is comprised of multiple types of providers financed by a myriad of federal health and supportive service programs primarily, but also income assistance and housing programs to a lesser extent.

A number of options for change in federal policy have been considered over the years including: developing new grant programs that expand supportive and health services that allow people to receive more care outside of institutions; expanding public financing for a broad range of long-term care options, either by extending Medicare and/or Medicaid coverage or by establishing a new prepaid public insurance program; and/or integrating various components of the previous approaches in a manner that strikes a balance between private responsibility and shared public concern.

A thorough understanding of the characteristics of persons who need long-term care is an essential element of efforts to redesign current national policy. These characteristics can inform Congressional decisions about target populations for national reform initiatives and specific eligibility criteria for individual participation in new or expanded long-term care programs. Through the application of proxy measures such as limitations in persons abilities to conduct activities of daily living, national survey data can be used to estimate long-term care needs within various population cohorts. In some instances, states have translated similar data into eligibility criteria for their long-term care programs. In addition, various federal laws define disability and need for services in many different ways.

Requirements: Students will be expected to investigate certain aspects of criteria that determine the need or the eligibility for long-term care assistance through an analysis of (1) national surveys (e.g., National Long Term Care Survey and the Health and Retirement Study) of populations in need of or receiving long-term care services; (2) state policies that define eligibility for long-term care services under their programs; and (3) definitions of disability as stipulated by various federal programs and tax law. In addition, students will conduct a 50-state survey designed to collect state definitions of functional eligibility for nursing home care and selected home and community-based services financed through the Medicaid program (and perhaps other state funded home and community-based services programs. This phase of the project will involve analyses of state laws, program policies, and manuals to ascertain the definitions. For a subset of states, the students will compile information on eligibility for selected programs for persons with mental retardation and developmental disabilities. Students will prepare reports on their findings. This project would complement other on-going work on long-term care being done in the Division. The CRS Project Coordinator is Carol O'Shaughnessy.

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