Chronic and Complex Populations – Page 18 – The National Academy for State Health Policy

June 22, 2020/in The RAISE Act Family Caregiver Resource and Dissemination Center Blogs, Featured News Home Council Meeting Materials and Resources, The RAISE Family Caregiver Resource and Dissemination Center /by Paige Spradlin, Salom Teshale and Wendy Fox-Grage

The Family Caregiving Advisory Council held its third full council meeting on May 20 and 21, 2020, to hear presentations on key topic areas, including family leave, respite care, research and data, and an analysis of the input received from the Administration for Community Living’s (ACL) request for information. The council also refined its Driver Diagram to identify a set of recommendations to support family caregivers. A Driver Diagram is a visual display of a group’s philosophy on what “drives” or contributes to the fulfillment of a project goal. The Family Caregiving Advisory Council is developing a Driver Diagram as a consensus building tool to form the creation of the national strategy on family caregiving.

Family Caregivers and COVID-19

The second council meeting began with remarks from ACL Administrator and Assistant Secretary for Aging Lance Robertson who thanked council members for their flexibility, resilience, and dedication during the COVID-19 pandemic, which has further demonstrated how critical it is to have the right supports in place for caregivers. Robertson also acknowledged:

The $100 million of funding ACL received from the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Families First Coronavirus Response Act that it awarded to states to help strengthen the caregiver support program;
The progress to date on ACL’s Report to Congress; and
The continued engagement of federal partners in supporting this work

Public Input

Through a request for information process, the ACL accepted comments from the public on key questions related to the RAISE Act and family caregiving. The public comment period for the request for information closed on Feb. 7, 2020.

Pamela Nadash, PhD, a professor at University of Massachusetts Boston, presented her team’s analysis of the input received from the ACL’s request for information to council members. The request generated 1,613 total responses, 75 percent of which were from individual family caregivers across the age spectrum and of varying racial and ethnic backgrounds with the remaining responses from organizations. The findings included:

Respondents requested additional supports for service planning, family-centered care, and respite services.
Family caregivers were concerned about financial security; many cited the need for a flexible work environment, part-time options, and paid time off.
Respondents recommended payment for family caregivers, including in the form of tax benefits for purchasing supplies necessary to support their family caregiving.
Many respondents expressed the impact caregiving has on their own physical and mental health.

Family Leave: Lynn Friss Feinberg with the AARP Public Policy Institute gave a presentation on the importance of family leave for employed family caregivers. Unlike previous generations, most (61 percent) family caregivers today work at a paying job. Family caregivers who stop working can face short- and long-term financial risks, including a loss of income, health insurance, Social Security and retirement benefits, and career opportunities. Council members discussed a variety of ways to support the financial security of family caregivers, including the provision of paid family leave, paid sick days, and family caregiver tax credits as well as prohibiting discrimination based on one’s family caregiver status among other protections.

Respite: Jill Kagan with the ARCH National Respite Network gave a presentation on respite care, including the different types of respite and the importance of person- and family-centered respite options. The presentation also noted the pandemic’s effects on respite availability and provision. COVID-19 has necessitated non-traditional ways of providing respite, including online interactions or phone calls, with some states having designated respite providers as essential workers. The presentation provided information on the advantages of respite on family caregivers’ well-being and health and how respite can be most effective. Kagan offered suggestions on how to improve respite access and provision for the council’s discussion.

Data and Research: Scott Beach, PhD, with the University of Pittsburgh gave a presentation on evidence-based family caregiver research and interventions, and Joe Caldwell, PhD, with Brandeis University gave a presentation on family caregiver data.

Beach’s presentation included a broad overview of family caregiver intervention literature, and he noted gaps in the literature, such as the fact that the majority of caregiving intervention studies focused on older adult populations, particularly dementia caregivers. He highlighted the opportunity to study caregivers of individuals across the lifespan, caregivers of individuals with disabilities and special health needs, and underrepresented groups such as minority caregivers, rural caregivers, or LGBT caregivers. Additionally, less is known about cost-effectiveness and economic impacts of caregiving on family finances. A barrier to implementing interventions is translating interventions from randomized trials to real-world settings. What is known about effective interventions is that they must be multi-component and address both the pragmatic and the emotional elements of caregiving.

Caldwell’s presentation stressed the need to collect family caregiver data and information in general, noting that most national surveys do not contain questions about family caregiving. Information about caregiver data collection at the state level was also noted. Caldwell provided suggestions on a potential set of core caregiving questions to consider, and also discussed the possibility of including questions in current, existing surveys. Additionally, he noted that programs such as Medicaid were another source of potential data.

In the discussion, the Council discussed a number of considerations around caregiving data and research, including efforts around data collection from federal agencies and ways to explore the economic impacts of caregiving and evidence-based practices.

Driver Diagram Discussion: The final part of the meeting was a council discussion on the Driver Diagram. The Council previously voted on a set of goals to include in the Driver Diagram at the February 2020 meeting. At the May meeting, the council worked on brainstorming strategies, actions, and recommendations to support family caregivers.

Next Steps: The two-day meeting concluded with a recap of the day’s presentations and decisions on next steps. The council voted to hold all meetings as virtual meetings through the end of 2020 because of the pandemic. The council also voted to hold a full council meeting in July. ACL reviewed its next steps of working on stakeholder engagement and engagement with federal partners, along with plans to further support the council in developing the Driver Diagram. The council received information about focus group listening sessions for family caregivers occurring at the end of May and the beginning of June.

Toolkit: National Standards for Children and Youth with Special Health Care Needs

June 11, 2020/in Policy Toolkits Behavioral/Mental Health and SUD, Care Coordination, Children/Youth with Special Health Care Needs, Children/Youth with Special Health Care Needs, CHIP, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Eligibility and Enrollment, EPSDT, Featured Policy Home, Health Coverage and Access, Health Equity, Health IT/Data, Healthy Child Development, Integrated Care for Children, Integrated for Pregnant/Parenting Women, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Physical and Behavioral Health Integration, Population Health, Quality and Measurement, Social Determinants of Health /by NASHP Staff

The National Standards for Systems of Care for Children and Youth with Special Health Care Needs (CYSHCN) define the core components of a comprehensive, coordinated, and family-centered system of care for CYSHCN.

NASHP Awards Contracts to National Alliance for Caregiving and Advancing States to Support the RAISE Family Caregiving Council with Funding from The John A. Hartford Foundation

June 2, 2020/in The RAISE Act Family Caregiver Resource and Dissemination Center Council Meeting Materials and Resources, State Resources, The RAISE Family Caregiver Resource and Dissemination Center /by NASHP Staff

To better address the needs of family caregivers, the National Academy for State Health Policy (NASHP) has awarded contracts to National Alliance for Caregiving (NAC) and ADvancing States. Under the contracts, ADvancing States will conduct listening sessions with state aging and disability officials and NAC will hold a listening session with family caregiver advocates and to collect family caregiver vignettes. These activities will provide important information to the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregiving Advisory Council and support its work in crafting recommendations and building a national strategy to support family caregivers.

This initiative is one component of NASHP’s RAISE Act Family Caregiver Resource and Dissemination Center, which is funded by The John A. Hartford Foundation. The center serves as a national focal point for resources, technical assistance, and policy analysis for states, the broader community of stakeholders, and the public. Under the auspices of the Administration for Community Living, the council will provide a framework for how the federal government, states, and communities can better address the needs of family caregivers.

National Standards for CYSHCN One-Pagers Showcase Most Utilized Domains

June 1, 2020/in Policy Featured News Home Children/Youth with Special Health Care Needs, Children/Youth with Special Health Care Needs, Chronic and Complex Populations, Integrated Care for Children, Maternal, Child, and Adolescent Health /by NASHP Staff

Q&A: A Deep Dive into New York’s Drug User Health Hubs with New York’s Allan Clear

May 18, 2020/in COVID-19 State Action Center New York Blogs, Featured News Home Behavioral/Mental Health and SUD, Chronic and Complex Populations, Chronic Disease Prevention and Management, Health Equity, HIV/AIDS, Population Health, Social Determinants of Health /by Eliza Mette

The COVID-19 pandemic poses unique risks to people with opioid use disorder (OUD). Overdose risk increases when using individuals are in isolation and injection drug users are at higher risk of COVID-19 mortality due to increased rates of other infectious diseases and negative health effects from substance use.

State-supported comprehensive harm reduction programs that often provide sterile syringes, naloxone to reverse opioid overdoses, and education and counseling have shown encouraging results and remain critical during the current crisis. As policymakers face tough budget decisions in the coming months, understanding the value of harm reduction services will be increasingly important.

The National Academy of State Health Policy (NASHP) recently spoke to Allan Clear, director of the New York State Department of Health’s AIDS Institute’s Office of Drug User Health to identify the effectiveness of these programs. The institute’s Office of Drug User Health operates the state’s Syringe Exchange Program, Expanded Syringe Access Program, Opioid Overdose Prevention Program, Increasing Access to Buprenorphine Program, and Drug User Health Hubs. Clear has worked with people with substance use disorders (SUD) for decades and ran one of New York’s first syringe exchanges.

Describe the history of harm reduction in New York.

We had been doing underground needle exchange in New York City. The state Department of Health had been monitoring what we were doing and recognized that syringe exchange was of value and important in terms of the HIV epidemic. When the Foundation for AIDS Research said it was going to fund programs in New York City, that’s when the AIDS Institute stepped in, developed regulations, and amended the public health law on syringes, which allowed us to move forward legally and with the blessing of the government.

Learn how states address Co-Occurring hepatitis C, HIV, and SUD:

Read the NASHP report, Tackling the Trifecta: State Approaches to Addressing Co-Occurring Substance Use Disorders, HIV, and Hepatitis C.

Register for the NASHP webinar, Tackling the Trifecta: How States Are Addressing Co-Occurring SUD, HIV, and Hepatitis C, from 2-3 p.m. (ET) Tuesday, May 26, 2020. It features a discussion by state officials about harm reduction during COVID-19.

You don’t see it in documents, but New York state has invested heavily in harm reduction over the years, so our overriding philosophy in the AIDS Institute and Office of Drug User Health is a harm reduction approach.

Why is there an emphasis on people who inject drugs as a distinct service population?

I personally don’t think harm reduction would be necessary if we treated people who use drugs in the way we treat people with ‘medical’ problems. We have a health care system which we call “drug treatment,” which has been developed completely outside of the health care system, which I think is fairly unusual. If you have a pain in your neck or a pain in your stomach, you go to your doctor. If you have a substance use issue, you have to completely navigate an unknown and foreign system to find help. And that help is not in any form of outreach – it’s just waiting for you to find it. And then it’s a very imprecise and inaccurate response to your medical problem. The drug treatment system has never really gotten behind efforts that embrace people who use drugs, as opposed to people who desire to stop using drugs, and people sort of dip in and dip out of the treatment system. And I commend [our] agency for saying, “we do drug user health.”

Describe the inception of the drug user health hub program.

The best health care delivery system for people who use drugs would be the existing health care system. Ideally, we would destigmatize drug use to the extent that it becomes a normal thing for people who use drugs to get a compassionate response and quality health care when they enter the health care system. However, at this moment in time, we don’t have that, so we have to develop a system that exists outside of the mainstream medical system. This is why in New York, we have 24 syringe exchange programs (SEPs), and 12 of them are designated as drug user health hubs.

What is the process for becoming a drug user health hub?

[There is no formal certification process. Selected programs are given additional funding to enhance their regular programming in order to incorporate low-threshold medical care – an approach that offers services without attempting to control a patient’s intake of drugs and provides counselling only if requested.] The office approached a SEP in Albany, that already had a Law Enforcement-Assisted Diversion (LEAD) program, so, they added on extra case management staff to work with the pre-arrest diversion from the Albany police department. The office also approached a SEP in Buffalo, which had been extremely hard hit by overdoses. They used the money to build up capacity to respond to overdoses internally and to conduct outreach and anti-stigma work within the community, as the Buffalo police department was not carrying naloxone at the time. In Ithaca, they did a great deal of work around exploring drug policy reform and decided to do low-threshold buprenorphine program at their SEP. Over time, we’ve added another nine programs.

What are some of the most important services provided by a drug user health hub?

There are also so many restrictions and problems for doctors to prescribe buprenorphine that there’s a big shortage of providers who are willing to do it. We sort of saw buprenorphine as a frontline medication that prevents death from heroin or opioid overdose, and what we have been promoting is that we provide the medication and then find out what the person wants.

[Clear and his colleagues discovered that once people are properly treated and given assistance with resume drafting and interview techniques to help them return to the workforce, they were more amenable to addressing their secondary health needs, including hepatitis C. Describing the individuals that benefit from the services the hubs provide, Clear said, “people would come back and would be interested in other health care – they want other elements of their care addressed. They now have found a venue where they are welcome and where they get the care that they need.”]

How do the efforts of the Office of Drug User Health play into addressing infectious disease?

[Using the opioid overdose reversal drug naloxone as an example, SUD and infectious disease are intertwined.] Naloxone is not really about HIV – it’s obviously about keeping people alive who consume opioids. Back in the late 80s and early 90s, people who inject drugs drove the epidemic here, and now we’re down to something like less than 2 percent a year of new infections among people who inject drugs. The other element in there now that we talk about a lot is invasive infections, so MRSA, staph infections, endocarditis, all of which are on the increase among people who use drugs. We’re doing a lot of work around supporting staff in emergency departments (EDs) to recognize signs of SUD, conduct screening in the ED to see if someone does have an OUD, or if someone shows up with a staph infection to investigate their injection practices.

How would you apply what you’ve seen over the years to the work that needs to be done systemwide?

I’ve been around since the start of the AIDS epidemic and have seen the response and know how to address serious health epidemics for people who use drugs, and here we are – two and a half decades later – still trying to integrate health services …for people who use drugs into a health system that is not receptive to them. It makes me think, “Why didn’t we learn our lesson? Emerging from the AIDS epidemic, why didn’t we make those changes that were sustainable?” I’m hoping that we can, certainly with our office and the relationships we have built with other entities. We should be able to do something that is lasting and transformative.

Strengthening Workforce Capacity: State Actions to Address Opioid Use Disorder during COVID-19

May 18, 2020/in COVID-19 State Action Center Blogs, Featured News Home Behavioral/Mental Health and SUD, Chronic and Complex Populations, Chronic Disease Prevention and Management, COVID-19, Health Coverage and Access, Health Equity, Physical and Behavioral Health Integration, Population Health, Social Determinants of Health, Workforce Capacity /by Kristina Long and Jodi Manz

During the COVID-19 pandemic, the opioid epidemic has quietly raged on, requiring states to fight a costly, two-front war. While states have rallied to ensure that opioid use disorder (OUD) treatment remains accessible, organizational and workforce challenges persist and the resources and revenue needed to address them are rapidly changing.

Gaps in treatment infrastructure and behavioral health workforce shortages have historically challenged states’ OUD treatment delivery. In the midst of the pandemic, states are optimizing current flexibility and supports for their behavioral health workforces to help maintain treatment access during the COVID-19 pandemic, while also monitoring how or whether these new strategies will be maintained in the future.

Here are some approaches states are taking to increase access to treatment and address workforce shortages by expanding job descriptions, offering flexible training, and changing licensing requirements:

Modifying licensure requirements. Licensing requirements for providers vary significantly by state, creating barriers for out-of-state practitioners to providing services across state lines. Expanding out-of-state license recognition and preventing licensure lapses can help ensure and expand access to treatment, promote adoption of telehealth services, and address provider shortages.

New Hampshire, New York, and Pennsylvania have all expanded the ability of out-of-state providers to deliver services within their states through executive orders. New Hampshire allows out-of-state providers to deliver medically necessary services both in person and via telehealth. Similarly, Pennsylvania has issued temporary licenses for out-of-state medical providers and has expedited issuance of temporary licensing. New York has allowed providers licensed in other states and Canada to practice in the state without penalty due to lack of licensure.
States may also consider delaying the expiration of provider licenses during the pandemic to remove any potential barriers providers may have to delivering services. Following an executive order that extended license expiration dates across provider types, Maryland’s Behavioral Health Administration (BHA) released guidance on licensure extension and new licensure processing specific to behavioral health providers. Professional licenses that would have expired during the period of the current emergency will be extended for 30 days after the emergency order is lifted, though the BHA continues to process licensure and re-licensure applications that are mailed or submitted electronically.

Leveraging licensed providers. As states face workforce shortages that are amplified by COVID-19, officials may find opportunities to leverage licensed providers in unique capacities, particularly in the provision of OUD treatments.

In Massachusetts, under order of the commissioner of public health, pharmacists may now administer medications for opioid use disorder (MOUD) in clinical settings, a policy shift designed to allow nursing staff who ordinarily handle such responsibilities to be reassigned to treat COVID-19 patients.
The Ohio’s Board of Pharmacy has adopted temporary regulatory guidance to allow authorized prescribers in opioid treatment programs (OTP) to delegate buprenorphine administration to registered nurses (RNs) and licensed practical nurses (LPNs).

Providing buprenorphine waiver trainings. States have been working to encourage and train providers to become “waivered” or licensed to prescribe buprenorphine long before this pandemic began, and several organizations are now taking advantage of increased flexibility in provider schedules to provide training. Anticipating that overdoses may increase during the pandemic, states can encourage provider engagement with these and similar programs to grow their waivered workforce.

California Bridge, a program supported in part by the California Department of Health Care Services (DHCS), is offering free online buprenorphine trainings that emphasize the immediate needs of vulnerable individuals during COVID-19.
Get Waivered, a non-profit program promoting and providing emergency department (ED) provider training, is offering a “Get Waivered Remote” training aimed at ED providers and medical students, recognizing that with clinics operating at limited capacity during the COVID-19 pandemic, EDs may become a more necessary point of care for people with OUD. This training is free and fully remote.

Supporting behavioral health workforces. As with other frontline workers, behavioral health staff working in residential care, institutional settings, and in direct contact with patients are experiencing significant stress working during the pandemic. To support staff without creating new programs and resulting budget demands, states may consider developing resources to support the mental health needs of both licensed and unlicensed workforces.

The Interim COVID-19 Guidance to Providers and Stakeholders for Behavioral Health and Homelessness Services from the Hawaii Department of Health includes specific burnout prevention and self-care strategies for providers to reduce secondary trauma and help monitor workload and stress.
Through support provided by the Washington State Health Care Authority and the Division of Behavioral Health and Recovery, the Washington Council for Behavioral Health has developed BH Providers Connect, a listserv for behavioral health providers to connect and support one another through the COVID-19 pandemic.
As part of their COVID-19 response, Michigan has released “Supporting Emotional Health of the Behavioral Health Care Workforce during COVID-19,” a guide that outlines self-care strategies, resources for providers and their families, and stress management techniques. Additionally, in response to the heightened stresses on long-term substance use disorder recovery, Michigan has also developed guidance on supporting peers during this pandemic.

While these steps in response to COVID-19 are designed to address concerns about treatment access during the pandemic – sometimes, explicitly – policymakers are also considering the long-term service and budget implications of these changes. In a time of historically reduced state revenues, leaders will be considering how policy shifts and adjustments made during this pandemic can or should be adapted for the post-pandemic treatment of OUD, with likely fewer resources to do so.

State Approaches to Family Caregiver Education, Training and Counseling in Medicaid Home- and Community-Based Services

May 4, 2020/in The RAISE Act Family Caregiver Resource and Dissemination Center Charts, Featured News Home, Maps Chronic and Complex Populations, Chronic Disease Prevention and Management, Health Coverage and Access, Palliative Care, Population Health, State Resources, The RAISE Family Caregiver Resource and Dissemination Center, Workforce Capacity /by Salom Teshale

State Approaches to Family Caregiver Education, Training, and Counseling

April 28, 2020/in The RAISE Act Family Caregiver Resource and Dissemination Center Blogs, Featured News Home Chronic and Complex Populations, Chronic Disease Prevention and Management, COVID-19, Population Health, State Resources, The RAISE Family Caregiver Resource and Dissemination Center /by Salom Teshale, Eliza Mette, Paige Spradlin and Wendy Fox-Grage

State Medicaid home- and community-based waivers and state plan amendments can provide critical information, counseling, and training to family caregivers. Recently, the National Academy for State Health Policy (NASHP) reviewed states’ Medicaid 1915(c) and 1115 waivers, and 1915(i) and 1915(j) state plan amendments (SPAs) that focuses on waivers and state plan amendments covering older adults and adults with physical disabilities, to highlight their unique approaches to training and supporting caregivers.

Family caregivers provide increasingly intense and complex care that requires them to learn how to perform difficult medical and nursing tasks. Training and other supportive services offered through Medicaid waivers and state plan options can be important tools to assist the caregivers of Medicaid enrollees with long-term needs, promote better care, and potentially delay admission to higher levels of care. As many individuals are confined to their homes due to the COVID-19 pandemic, reliance on these services and supports provided by family caregivers is greater than ever.

Findings

Twenty-four states include education, training and counseling for family caregivers in their 1915c and/or 1115 waivers. Fifteen states use their 1915c waivers to provide these services; six states provide services through a 1115 waiver; and three (Minnesota, South Carolina, and Washington State) include services in both 1915c and 1115 waivers. While states often include these services (particularly within 1915c waivers), states varied greatly in identifying which caregivers were eligible for training, education, and/or counseling services and which services were provided. States also varied in their requirements for how the need for these services was documented.

States define informal or unpaid caregivers using a range of familial relationships. Florida, Rhode Island, and Utah define unpaid caregivers in their states’ waivers as “any person, family member, neighbor, friend, companion, or coworker who provides uncompensated care, training, guidance, companionship or support to a person served.” Georgia is the only state to specify that spouses, in particular, currently are not eligible for specific waiver caregiver education and training services. Georgia and Indiana specified in their waiver service definitions that caregivers had to live with care recipients to qualify as caregivers who could receive specific caregiver education and training services.

Several states make distinctions between paid and unpaid caregivers.

Seven states (FL, CA, MD, OR, RI, UT, WA) provide education and training services for unpaid caregivers. For example, Washington State’s 1115 waiver includes education and training for unpaid caregivers through its Medicaid Alternative Care (MAC) program, and Rhode Island’s 1115 waiver includes unpaid caregiver training and counseling services.
Four states (HI, PA, WI, MN) specify that both paid and unpaid caregivers may qualify for specific training services. Hawaii’s 1115 waiver and Pennsylvania’s and Wisconsin’s 1915c waivers specify that paid and unpaid caregivers can access specific services. Minnesota’s 1915c waiver specifies that only consumer-directed community supports services can be used to purchase training for paid or unpaid caregivers. Other waiver services are for informal or family caregivers, and its 1115 waiver mirrored the 1915c waiver.

States’ training and education includes a range of topics and modalities. Collectively, states list a range of different types of training related to medical care, including but not limited to education and training on:

Specified medical equipment;
Medical treatment;
Personal care assistance;
Medications;
Performance of instrumental/activities of daily living (I/ADLs) or body movements; and
Disease pathways or specific conditions.

Eight states (MA, MN, NJ, UT, TN, SC, WA, and WI) listed some kind of formalized training related to providing care. Collectively, states listed various types of services, including evidence-based programs, seminars, group training, or reimbursement for conference attendance. For example, Minnesota allows costs of training and conference registration fees to be included in training and education, but does not cover transportation, travel, meals, or lodging. One state, Maryland, explicitly excludes group or classroom training.

Several states also covered caregiver-specific services, such as:

Financial support for attending caregiver-related training programs;
Support groups;
Non-psychiatric counseling services;
Caregiver coping skills building; and
Consultation services.

Hawaii, Iowa, Washington, Minnesota, and New Jersey specifically mention counseling or similar services aimed at caregivers. Iowa’s 1915c waiver includes counseling that could address adjusting to a care recipient’s disability or terminal condition. Two states, New Jersey and Washington State in their 1115 waivers, include training on coping skills as a caregiver support. New Jersey offers seminars, including a seminar on coping skills for caregivers of individuals with long-term care needs. Hawaii includes “supportive counseling” and family therapy in its waiver service list.

States require these services to be included in assessments and care plans.

All states with training, education, and/or counseling services for family caregivers include language in waivers that these services must be listed under a care or support plan, evaluation, service plan, therapeutic regimen, or some other type of identification or assessment in order to be reimbursed. Washington State’s 1115 waiver requires caregivers to complete a specified caregiver screening and, as needed, a specified caregiver assessment to determine qualification for specific tiers of services. Tennessee includes caregivers in its face-to-face assessment – assessing caregiver well-being and continued ability to provide care.

Conclusion

States have great flexibility with Medicaid waivers and state plan amendments to provide education, training, and counseling to family caregivers. Several states also incorporate flexibility into the types of training that can be provided to caregivers, often specifying a range of caregiver education, training, and/or counseling opportunities.

Recognizing that states depend on family caregivers to provide critical support to help relatives, friends, and neighbors, especially during the pandemic, NASHP will be publishing state resources on Medicaid policies supporting family caregivers through the RAISE Act Family Caregiver Resource and Dissemination Center with support from The John A. Hartford Foundation and in collaboration with the US Administration for Community Living. NASHP will analyze topics including respite services, reimbursement for caregivers, and paid leave in its future work.

Note: State-only funded programs as well as waivers and amendments for children and people with intellectual/developmental disabilities are not included in this analysis.

Information for Wyoming and Kentucky was not available for this analysis.

CAPC Factsheet: Palliative Care Across Settings

Map: Public Education Programs

Family Caregiving Council Receives Public Input and Expertise to Create Recommendations

NASHP Awards Contracts to National Alliance for Caregiving and Advancing States to Support the RAISE Family Caregiving Council with Funding from The John A. Hartford Foundation

National Standards for CYSHCN One-Pagers Showcase Most Utilized Domains

State Approaches to Family Caregiver Education, Training and Counseling in Medicaid Home- and Community-Based Services

State Approaches to Family Caregiver Education, Training, and Counseling

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