Medicaid Home and Community-Based Services Data, 2008
Terence Ng and Charlene Harrington
Introduction
In 2008, the federal-state Medicaid program paid for 42 percent of the totIn 2008, the federal-state Medicaid program paid for 44 percent of the total national long-term care expenditures. This part of the website introduces a series of tables that present the latest available (2007) state-by-state, participant and expenditure data for the three main Medicaid home and community-based service (HCBS) programs, and for total Medicaid Long-Term Care. The three main Medicaid programs are: 1915(c) waivers, home health, and state plan personal care. Each of these programs is described briefly below. Further information on the programs and detailed data analyses are available in Center for PAS HCBS project publications. The waiver data are taken from the Form 372 reports that states submit annually to Centers for Medicare and Medicaid Services (CMS). The home health and state plan personal care data are collected annually by PAS Center researchers using a survey of state officials. In addition, the total long-term care tables also shows the percentage of Medicaid long-term care participants being served in home and community-based services.1
Medicaid HCBS Programs
The only two mandated Medicaid long-term benefits are institutional care and home health services for participants eligible for institutional care. Medicaid regulations do, however, allow states to use combinations of three programs to provide HCBS either directly, or through a variety of contractual arrangements: 1915(c) HCBS waivers, home health, and state plan personal care services.
Waivers.
Since 1981, states have used authority under Section 1915(c) of the Social Security Act to request a waiver of certain federal Medicaid requirements (including state-wide program coverage) to establish HCBS 'waiver' programs. These programs attract federal-matched funds and allow states to provide a wide range of HCBS to participants who would otherwise be in an institution, including: optional Medicaid benefits (e.g., personal assistance), and services not otherwise authorized by federal Medicaid statute (e.g., home modifications). Every state and DC has at least 2 waivers except for Arizona and Vermont, which provide Medicaid long-term care through 1115 demonstration waivers.
Personal Care Services.
Since 1975, states have had the option of offering personal care services (PCS) as a Medicaid benefit. States have considerable discretion in defining PCS but programs typically involve non-medical assistance with activities of daily living (e.g., bathing and eating) for participants with disabilities and chronic conditions. States are known to vary in the amount and scope of services provided (e.g., only some states provide PCS outside the participant's residence). Unlike waivers, if PCS is offered as a state plan benefit, it must be made available statewide, to all categorically eligible persons. In 2008, 34 states offered the Medicaid Personal Care Services benefit but Rhode Island and Delaware reported no participants.
Home Health.
For Medicaid participants other than those eligible for institutional care, Medicaid home health nursing services are optional. States can vary the amount, scope and duration of benefits offered so long as they remain sufficient to reasonably achieve their purpose and remain the same for all eligibility groups. All states offer the Medicaid Home Health benefit
1. Percentage data obtained from Burwell, B., Sredl, S., & Eiken, S. (2009). Medicaid Long Term Care Expenditures in FY 2008. MN: Thomson Reuters.