Citation

Harrington, C., Newcomer, R., LaPlante, M., Kaye, S., Stoddard, S., Kitchener, M., & Oxford, M. (2004, November 15). Center for Personal Assistance Services. Presented at the National Association of State Medicaid Directors Fall 2004 Annual Meeting hosted by Held in Cooperation with the Centers for Medicare & Medicaid Services (CMS).
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Summary

Personal Assistance Services
PAS refers to formal and informal help provided to people with disabilities to assist them in tasks essential for daily living.

PAS, along with assistive technology such as wheelchairs, text readers and hearing aids, helps people with disabilities to participate in activities at home, at work and in the community.

Center for Personal Assistance Services
Primary Goal
To ensure that people with self- care limitations can live independently

Research Project 1: Formal and Informal PAS Statistical Studies
Specific studies examine:
Unmet needs for PAS
IADL/ADL levels by age
Differences in informal PAS hours
Differences in paid PAS hours
Changes in Need for PAS over time
PAS Need by age from different sources
Profiles of People Needing PAS
Out-of-pocket costs for PAS
Profiles of informal helpers

Research Project 2: Home & Community PAS
Track and analyze HCBS & PAS participants, expenditures, policies, programs, litigation, Olmstead plans, nursing home transition programs, federal and state demonstration projects
Interviews and focus groups with people who use paid PAS in selected states to identify barriers and criteria for best practices
Interviews of key informants to identify new models and best practices

Research Project 3: PAS Workforce
Major areas of focus across the US
Wages, Benefits, and Worker Support
Education and Training
Recruitment and selection
Retention strategies
Communications/coordination
Strategies to create high quality jobs

Special study of state PAS program in California

Research Project 4: Workplace PAS
Studies include:
Telephone interviews of employers, counselors and PAS users
Telephone focus group studies with selected employers
Mail surveys of employers
Tracking of PAS workplace changes
PAS Job Accommodation Ideas report
Training, Dissemination and Technical Assistance
New website: www.PAScenter.org
Quarterly email newsletters
Published papers and reports
Presentations and workshops
Courses and mentoring students
Technical assistance

Pressures to Expand PAS
Medicaid LTC & Older Americans Act in 2002
Medicaid LTC Participants by Provision Type, 2002 Total Participants: Est. 4.2 million
Medicaid LTC Expenditures by Provision Type, 2002 Total Expenditures: $83 billion
Federal/State Personal Care Services Programs
State Plan Personal Care optional benefit
Available in only 32 states (2002)
Must be statewide, available to Medicaid categorically eligible groups
HCBS waivers
Must be nursing home eligible, selective recipient groups
Slots & expenditures can be limited
Can limit financial and medical eligibility
Can restrict geographical areas
Older American Act
Available in all states
States set own eligibility criteria (60+ nationwide)
Medicaid 1915(c) HCBS Waivers: Program Trends, 1992-2002
Personal Care Participants & Expenditures by Program, 2002
Medicaid Waivers with Personal Care, Program Data by Target Group, 2002
National Personal Care Participants per 1,000 Population by Program, 1999 - 2002
National Personal Care CPI-Adjusted Expenditures per Capita by Program, 2002
Variation in Personal Care: Three Highest & Lowest States, Participants per 1,000 Population, 2002
Variation in Personal Care: Three Highest & Lowest States, Expenditures per Capita, 2002
Waiting Lists for Waivers with Personal Care Services in Selected States, 2002 (Total : 146,401)
Unmet Need for Personal Care
Large & long waiting lists for HCBS waiver programs with personal care in many states
State officials report many groups not served (e.g., TBI, HIV/AIDS, mentally ill)
Only 32 states offer Medicaid State Plan Personal Care Benefit
Cost of unmet need for Medicaid HCBS: $1.9bn for those living alone & $4.7bn for those living with others
Fiscal crises may impede Medicaid HCBS and OAA program growth

Conclusions
*Participation and Expenditure Trends
-Persistence of large state variation in HCBS program provision and growth
*Differential growth in Medicaid participants and expenditures
*Policy
-Need additional resources to expand PAS programs