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Home & Community-Based Services: State-Only Funded Programs in Pennsylvania

States may be required to contribute match funding to some federally funded long-term care (LTC) programs and to different extents. In FY 2003 states spent 21.4% of total state expenditure on Medicaid (NASBO, 2004). Total expenditures for HCBS are increasing and totaled $16.4 billion in FY 2001, with states paying between 1.7% and 13.3% of total health care expenditures on HCBS in FY 2001 (Milbank 2003). Medicaid spending grew quickly in the early 2000s, forcing state legislatures and officials to investigate ways to contain Medicaid costs rather than expanding services (Coleman et al 2003).

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Program Name: Options Program³,⁴,¹¹,³⁴

Administrative Agency: Dept of Aging

Population Served: Elderly & physically disabled adults (18-59)

Annual Expenditure: $206,617,706 FY02 Appropriation

Funding Source: State Lottery, general revenue, clients contribute + Federal funds (OAA Title III-E, Title XX)

Number of People Served: 229,506 FY02

Eligibility Criteria: 60+ needing help with 2-6 ADLs. Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid. No financial eligibility requirement. Assessment by AAA who may refer to waiver program. No income or asset limit.

Further Information: Cost control: Cost cap $625/mth. No service limits. Each AAA has a slot allocation & the aggregate cost of client care cannot exceed 45% of nursing home care costs. Co-pay on sliding scale if income above 125% FPL (2003, $935/individual), income at/above $2214/mth (300% FPL) pay full cost of service. Quality control: data analysis, on-site monitoring. Consumer direction Can be consumer directed. Other information Min. hrly wage $8 for home aides to attract workers, $0.10/hr increase to aides who recruit a friend.

Program Name: Bridge Program³,¹¹,³⁴

Administrative Agency: Dept of Aging

Population Served: Elderly (60+)

Annual Expenditure: N/A

Funding Source: Tobacco settlement funds, Client contributes

Number of People Served: N/A

Eligibility Criteria: 60+, require a nursing facility level of care but have a gross income of $1,656.00 or less/mth & assets of $2000 - $40,000. Assessment by AAA & care provided by list of approved providers. Cost share is 50% of service cost/mth.

Further Information: Consumer direction Can be consumer-directed Other information Program supplements services provided under the Attendant Care Waiver which was authorized in 1995

Program Name: Attendant Care Program¹¹,³⁴

Administrative Agency: Dept of Aging & Dept of Public Welfare

Population Served: Elderly (59+) Adults with disabilities (18-59)

Annual Expenditure: $47,031,000 (FY04-05) (includes state match for waiver)

Funding Source: N/A

Number of People Served: N/A

Eligibility Criteria: Functional eligibility requirements are the same as for the Medicaid Attendant Care waiver but there is no reported financial eligibility requirement.

Further Information: Consumer direction Consumer-directed - hire, fire, train & pay personal attendants. Other information Program authorized by the state Attendant Care Act 150, 1986 & supplements Attendant Care waiver services.

Program Name: Family Caregiver Support Program³,⁴,¹¹,³⁴

Administrative Agency: Dept of Aging

Population Served: Elderly (60+) or adults with dementia.

Annual Expenditure: $11,500,000 FY01

Funding Source: General Revenue

Number of People Served: 8,02 FY02

Eligibility Criteria: Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid. Assistance on a sliding scale based on income. Person must be 60+ & require help with 2+ ADLs or have dementia if under 60. Limited financial assistance (e.g. equipment not covered by Medicaid) is available for people with income at/below 380% FPL. No asset limit.

Further Information: Cost control: Cost cap $200/mth. No service limits applied. Quality control: on-site monitoring & data analysis. Consumer direction Can be consumer directed. Other information Supplements the federally funded Family Caregiver Support Program, it started as a demonstration project in 4 counties & spread statewide 1990.

Program Name: Risk Reduction through Assistive Technology⁴

Administrative Agency: N/A

Population Served: Elderly (60+)

Annual Expenditure: $1,000,000 FY02 Appropriation

Funding Source: Tobacco fund

Number of People Served: 345 FY02

Eligibility Criteria: Income limit $923/mth, no asset limit.

Further Information:

Abbreviations:

AAAs - Area Agencies on Aging.

ADL - Activities of Daily Living.

AT - Assistive Technology. Dept - Department.

FY - Financial Year.

HCBS - Home & Community-Based Services.

LTC - Long Term Care. Mth - month. Rehab - Rehabilitation.

Mth - month.

Rehab - Rehabilitation.

SCI - Spinal Cord Injury.

SSBG - Soical Services Block Grant.

TBI - Traumatic Brain Injury.

Wk - week.

Yr - year.

Footnotes:

(a) Note that some figures listed are the yearly appropriation, not expenditure.

(b) Sources of funding are listed in the language with which they are reported.

(c) The figures for number of participants are not necessarily figures for unduplicated participants.

Notes:

(1) The definitions of the services provided in programs may differ between states.

(2) Unless otherwise stated, programs are statewide.

(3) Programs where it is known that funding may come from a variety of sources, including non-state only funds (e.g. Older Americans Act) are indicated by the program name in italics.

(4) The table does not include Mental Health Services programs.

(5) All information is the most up-to-date found from secondary sources noted in the references.

(6) N/A means the information has not been found (not available).

(7) all programs primarily aim to support people to live in the community, therefore there may be additional state only funded programs but these are not directly to support HCBS.

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