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The National Association of Medicaid Directors (NAMD) began as an independent, bipartisan, nonprofit professional organization in 2011. NAMD represents the leaders of state Medicaid agencies across the country. Established in 2011, NAMD’s mission is to support Medicaid Directors in administering the program in cost-effective, efficient and visionary ways that enable the over 70 million Americans served by Medicaid to achieve their best health and to thrive in their communities.

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Long-term services and supports (LTSS) are defined as the services and supports used by individuals of all ages with functional limitations and chronic illnesses who need assistance to perform routine daily activities such as bathing, dress- ing, preparing meals, and administering medications.

Further reading –

https://www.medicaid.gov/medicaid/ltss/index.html

Institutions for Mental Disease – In 1988, P.L. 100-360 defined an institution for mental diseases as a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged
in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services. This definition is in §1905(i) of the Act and in 42
CFR 435.1009. The regulations also indicate that an institution is an IMD if its overall character is that of a facility established and maintained primarily for the care and treatment of individuals
with mental diseases.

Facilities with fewer than 17 beds that specialize in treating persons with mental disorders can provide the types of services discussed in item 1 if they meet the regulatory requirements to
provide these institutional benefits, but these facilities are not technically IMDs. Because IMDs are defined to be institutions with more than 16 beds, the IMD exclusion applies only to
institutions with at least 17 beds.

Further reading –

http://dhhs.ne.gov/medicaid/Documents/4390.pdf

The Balancing Incentive Program provided financial incentives to States to increase access to non-institutional long-term services and supports (LTSS) in keeping with the integration mandate of the Americans with Disabilities Act (ADA), as required by the Olmstead decision and was created by the Affordable Care Act of 2010 (Section 10202). The Balancing Incentive Program authorized grants to serve more people in home and community-based settings, from October 1, 2011 to September 30, 2015. Thirteen States continue to participate in the program by spending the grant funds to increase access to new or expanded services and infrastructure.

Further reading –

https://www.medicaid.gov/medicaid/ltss/balancing/incentive/index.html

The Temporary Assistance for Needy Families (TANF) program provides grant funds to states and territories to provide families with financial assistance and related support services. State-administered programs may include childcare assistance, job preparation, and work assistance.

In order to qualify for this benefit program, the applicant must be either pregnant or responsible for a child under 19 years of age. Also the applicant must be a U.S. national, citizen, legal alien, or permanent resident; have low or very low income; and be under-employed (working for very low wages), unemployed or about to become unemployed.

Each state and territory decides the benefits it will provide. Each state and territory also establishes the specific eligibility criteria that must be met to receive financial assistance payments or other types of benefits and services. Thus, you must check with the TANF agency in the area that you reside to learn whether you are eligible to receive financial assistance or other TANF benefits and services.

Further reading –

http://www.tanf.us/

The Agency for Healthcare Research and Quality’s (AHRQ) mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.

Further reading –

https://www.ahrq.gov/

The Adoption and Foster Care Analysis and Reporting System (AFCARS) collects case-level information from state and tribal title IV-E agencies on all children in foster care and those who have been adopted with title IV-E agency involvement. Title IV-E agencies are required to submit AFCARS data semi-annually to the Children’s Bureau. The AFCARS report periods are October 1 through March 31 and April 1 through September 30. Data for each report period are due no later than May 15 and November 14, respectively.

ACF uses AFCARS data for a number of reasons, including the following:

Determining awards for the Adoption Incentives program
Preparing the Child Welfare Outcomes report
Conducting the Child and Family Services Reviews
Conducting title IV-E foster care eligibility reviews
Determining the allotment of funds for the Chafee Foster Care Independence program
Conducting trend analyses and short- and long-term planning efforts
Targeting areas for initial or increased technical assistance efforts, discretionary service grants, research and evaluation, and regulatory change
Responding to request for data from federal, state, tribal, and private agencies.

Further reading:

https://www.acf.hhs.gov/cb/research-data-technology/reporting-systems/afcars

Activities of daily living (ADLs or ADL) is a term used in healthcare to refer to people’s daily self care activities. The concept of ADLs was originally proposed in the 1950s by Sidney Katz and his team at the Benjamin Rose Hospital in Cleveland, OH and has been added to and refined by a variety of researchers since that time. Health professionals often use a person’s ability or inability to perform ADLs as a measurement of their functional status, particularly in regard to people post injury, with disabilities and the elderly. Younger children often require help from adults to perform ADLs, as they have not yet developed the skills necessary to perform them independently.

ADLs are defined as “the things we normally do… such as feeding ourselves, bathing, dressing, grooming, work, homemaking, and leisure.” A number of national surveys collect data on the ADL status of the U.S. population. While basic definitions of ADLs have been suggested, what specifically constitutes a particular ADL for each individual may vary. Adaptive equipment and devices may be used to enhance and increase independence in performing ADLs. Basic ADLs consist of self-care tasks that include, but are not limited to:

Bathing and showering
Personal hygiene and grooming (including brushing/combing/styling hair)
Dressing
Toilet hygiene (getting to the toilet, cleaning oneself, and getting back up)
Functional mobility, often referred to as “transferring”, as measured by the ability to walk, get in and out of bed, and get into and out of a chair; the broader definition (moving from one place to another while performing activities) is useful for people with different physical abilities who are still able to get around independently.
Self-feeding (not including cooking or chewing and swallowing)
One way to think about basic ADLs is that they are the things many people do when they get up in the morning and get ready to go out of the house: get out of bed, go to the toilet, bathe, dress, groom, and eat.

There is a hierarchy to the ADLs:” … the early loss function is hygiene, the mid-loss functions are toilet use and locomotion, and the late loss function is eating. When there is only one remaining area in which the person is independent, there is a 62.9% chance that it is eating and only a 3.5% chance that it is hygiene.”

Although not in wide general use, a mnemonic that some find useful is DEATH: dressing/bathing, eating, ambulating (walking), toileting, hygiene.

Further reading –

https://en.wikipedia.org/wiki/Activities_of_daily_living

The Americans with Disabilities Act (ADA) became law in 1990. The ADA is a civil rights law that prohibits discrimination against individuals with disabilities in all areas of public life, including jobs, schools, transportation, and all public and private places that are open to the general public. The purpose of the law is to make sure that people with disabilities have the same rights and opportunities as everyone else. The ADA gives civil rights protections to individuals with disabilities similar to those provided to individuals on the basis of race, color, sex, national origin, age, and religion. It guarantees equal opportunity for individuals with disabilities in public accommodations, employment, transportation, state and local government services, and telecommunications.

The ADA is divided into five titles (or sections) that relate to different areas of public life.

In 2008, the Americans with Disabilities Act Amendments Act (ADAAA) was signed into law and became effective on January 1, 2009. The ADAAA made a number of significant changes to the definition of “disability.” The changes in the definition of disability in the ADAAA apply to all titles of the ADA, including Title I (employment practices of private employers with 15 or more employees, state and local governments, employment agencies, labor unions, agents of the employer and joint management labor committees); Title II (programs and activities of state and local government entities); and Title III (private entities that are considered places of public accommodation).

Further reading –

https://adata.org/learn-about-ada