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Home and Community-Based PAS 
About this project
Recent studies have begun to describe the breadth and depth of Medicaid Home and Community Based Services (HCBS) programs more fully and although HCBS expenditures have increased rapidly from 1992 through 2006, states are facing serious budget problems which can jeopardize access to and funding for HCBS. This research project, which is directed by Terence Ng and Charlene Harrington at the University of California, San Francisco, is concerned with tracking changes and identifying gaps in these programs and services.
For the Center's purposes, the definition of the Home and Community Based Services includes:
All formal (paid) services delivered in the home and community, as opposed to institutional settings. These include personal assistance services, home health, waiver programs and other services funded by federal and state government. This research area has two goals.The primary goal of this five-year research project is with tracking changes and identifying gaps in HCBS programs and services. It comprises of three streams of research:
- Track and analyze trends in HCBS participants, services, and expenditures in state programs over time. Study conducted by Terence Ng and Charlene Harrington at UCSF. We will expand our existing state database on PAS, HCBS waiver programs, and home health services for 2007-2011 by collecting data annually from states.
- Track and analyze federal and state initiatives related to the Olmstead decision, waiting lists, Olmstead litigation, and other initiatives. Study conducted by Terence Ng and Alice Wong at UCSF.
- Track and analyze state PAS policies and barriers to PAS policies. This study will update 2004-2007 state policy data and barriers for 2008-12 on issues such as cost containment policies, eligibility standards, and consumer directed services. This study is being conducted by Terence Ng and Charlene Harrington at UCSF.
A second goal is to develop effective evidence-based interventions to address the needs for PAS. Three projects address interventions.
- Track and analyze state PAS interventions strategies and factors that impact expanding PAS. Study conducted by Charlene Harrington, Terence Ng, Martin Kitchener, and Nancy Miller.
- Examine the cost effectiveness of Medicaid HCBS waivers as an evidence-based intervention to provide PAS. Study conducted by Terence Ng, Charlene Harrington, Martin Kitchener, and Nancy Miller.
- Create a comprehensive state level databasee on registries and other intermediaries and evaluate their effectiveness in addressing unmet needs for PAS. Study conducted by Dorie Seavey and Radha Biswas at PHI
Promising Programs
The Center for Personal Assistance Services is conducting
a study of Medicaid Optional State Plan Personal Care Services (PCS)
programs. The study involves two main activities. First, better practices
(e.g., consumer direction) are identified from the literature to use
as criteria for selecting promising programs. Second, detailed case studies
are conducted on the promising programs.
 State by State Home and Community-Based PAS Data Available
State Medicaid 1915(c) HCBS Waiver Contact Info and Descriptions
Find contact information and learn about each Medicaid 1915(c) HCBS waiver
in any state.
The 1999 Olmstead Supreme Court Decision
In a landmark interpretation of the ADA (Americans with Disabilities Act),
the Supreme Court decided that people with disabilities have a right to receive
care in the most integrated setting appropriate and that unnecessary institutionalization
violates the ADA. All states must now comply with the decision. The Center
for PAS is tracking the legal and policy ramifications of the Olmstead decision
in each state.
State by State Medicaid Home and Community-Based Services for 2005
Find the total amount of expenditures, expenditures per 1,000 population,
the number of participants, and the participants per 1,000 population for
various Medicaid HCBS programs: Home Health, Personal Care Services, and
the 1915(c) HCBS Waivers. Compare these data with US totals.
State by State Medicaid 1915(c) HCBS Waiver Data for 2005
Find the total amount of expenditures, expenditures per 1,000 population,
the number of participants, and the participants per 1,000 population for
several waiver target groups. Compare these data with US totals.
State by State Wages for Personal & Home Care Aides, 1999 - 2008
Provides information on the wages received by Personal and Home Care Aides
in all 50 states, the District of Columbia and the nation over a 9 year period.
PAS Funding by State:
Federal funding
Shows the total funding by state from the Older American's Act Title III Programs and Alzheimer's Disease
Demonstration Grants.
State funding
State matched funding to some federally funded long-term care programs.
PAS Center Reports and Publications
A list of publications produced by the Home and Community-Based PAS
project. The citations provide links to abstracts, press releases, and
either the entire publication, or information about where to obtain it.
All PAS Center reports and publications related to Home and Community-Based PAS
Recent additions
Ng, T., Harrington, C. & O’Malley, M. (November 2009). Medicaid Home and Community-Based Service Programs: Data Update. Washington, D.C.: Kaiser Commission on Medicaid and the Uninsured. Retrieved December 8, 2009, from:
http://www.kff.org/medicaid/7720.cfm
View Abstract and Obtain Full Version Ng, T., Harrington, C., Kitchener, M. (2010). Medicare and Medicaid in long-term care. Health Affairs, 29 1, 22-28.
View Abstract and Obtain Full Version Okumura, M.J., Van Cleave, J., Gnanasekaran, S., & Houtrow, A. Understanding Factors Associated with Work Loss for Families Caring for CSHCN. PEDIATRICS Vol. 124 Supplement December 2009.
View Abstract and Obtain Full Version
Library
Citations and abstracts of important publications related to Home and
community-based PAS. Information on how to obtain the complete text is provided with each citation.
All Home and Community-Based PAS publications
Recent additions:
Wallace SP, Padilla-Frausto DI, Mendez-Luck CA, Benjamin AE, Durazo E, Pourat N. (February 2010). Budget Proposals Turn Back Clock 30 Years in Long-Term Care Services for California Seniors. Los Angeles, CA: UCLA Center for Health Policy Research.
View Abstract and Obtain Full Version Denny-Brown, N. & Lipson, D.J. (November 2009). Early Implementation Experiences of State MFP Programs. Washington, DC: Mathematica Policy Research, Inc.
View Abstract and Obtain Full Version Steenhausen, S. (January 2010). California’s Proposed 2010-2011 Budget: Senior-Related Program Reductions. Fact sheet, No.1. Long Beach, CA: The SCAN Foundation.
View Abstract and Obtain Full Version
Presentations
Presentations given by the Home and Community-Based PAS project with
links to abstracts, powerpoint files and summaries.
All Home and Community-Based PAS presentations
Recent additions:
Ng, T., Kitchener, M., & Harrington, C. (2007, November 19). Medicaid Long Term Care Home and Community Based Services for the Elderly: Trends in Programs and Policies. Presented at the 60th Annual Scientific Meeting of The Gerontological Society of America hosted by The Gerontological Society of America.
More information
Kang, T. (2007, November 7). Disparities in service utilization and expenditures for individuals living at home or in the community in California. Presented at the 2007 Annual Meeting & Exposition hosted by American Public Health Association (APHA).
More information
Vujovich, J., Loose, C., Kirby, S., & Kraus, L. (2006, October 5). Consumer direction: Taking it to the streets. Presented at the The 22nd National Home and Community Based Services Waiver Conference hosted by NASUA.
More information
Links
The Center for PAS has assembled a list of links to organizations,
resources and information available on the web related to Home and Community-Based PAS.
All Home and Community-Based PAS Links
Recent additions: Disability.gov
http://www.Disability.gov Disability.gov, is a redesigned federal Web site that connects more than 50 million Americans with disabilities to thousands of trusted resources on disability-related issues, programs and services. Formerly known as DisabilityInfo.gov, the site has been completely redesigned and updated with new social media tools, such as a blog and a Twitter feed, to encourage feedback and interaction among visitors. Disability.gov is not just for Americans with disabilities, but also for parents of children with disabilities, employers, workforce and human resource professionals, veterans, educators, caregivers and many others. Funding for Long-Term Care Programs
http://www.aarp.org/research/longtermcare/programfunding/ This link provides a collection of research reports, fact sheets, speeches, news releases, congressional testimony, legal dockets and opinions on the topic of "Funding for Long-Term Care Programs". Steve Gold’s Treasured Nuggets of Information
http://www.stevegoldada.com Steve Gold is an experienced disability rights attorney based in Pennsylvania. He maintains this website which is a very useful resource for anyone interested in disability rights in the U.S. The website provides regular bulletins on policy developments, legislation, research and statistics concerning five key issues for people with disabilities: housing, medical assistance/Medicaid, nursing homes, education, and the Americans with Disabilities Act.
The website presents short, easy to read bulletins and also give tips on how to use the facts and figures in state and local lobbying. It also presents sources of further information. It is possible to sign-up online to receive new bulletins by email and there is a searchable archive of all previous bulletins.
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