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

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: Statewide Head Injury Program¹⁸,¹⁹

Administrative Agency: Rehab Commission

Population Served: Anyone with a TBI

Annual Expenditure: $10,300,000 FY02

Funding Source: N/A

Number of People Served: 770 FY02

Eligibility Criteria: N/A

Further Information: Other information Community supports are available but very limited, due to funding

Program Name: Home Care Assistance Program¹⁸,¹⁹

Administrative Agency: Rehab Commission

Population Served: Adults with physical disabilities (18-59)

Annual Expenditure: $5,616,000 FY02

Funding Source: N/A

Number of People Served: 1,532 FY02

Eligibility Criteria: Not blind, functional impairment, lives alone or with another disabled person, meets financial guidelines, at risk of institutionalization.

Further Information: Cost control maximum 12hrs/week. Consumer direction Can be consumer directed.

Program Name: Home Care Program ³,⁴,¹⁸,¹⁹,²⁰

Administrative Agency: Office of Elder Affairs

Population Served: Elderly 60+, adults 18+ with a diagnosis of dementia & in need of respite.

Annual Expenditure: $150,000,000 FY02 appropriation (may include federal funds)

Funding Source: General Revenue, Clients contribute

Number of People Served: 39,000 (FY02) (may include federally funded clients)

Eligibility Criteria: Flexible functional & financial eligibility criteria (minimum of 4 ADL &/or IADLs with critical unmet need). Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid &/or individuals waiting placement on the Medicaid HCBS program or placement in a nursing home or individuals receiving Medicaid HCBS. No asset limit. Income limit annual gross income less then $20,779 (individual).

Further Information: Cost control: No service limits. Capped mthly payment to AAAs. Co-pay - mthly fee based on annual gross income ($7-$135/mth when individual income between $9,139-$20,778/mth). Quality control Peer reviews of assessments & care plans. Worker training. Background checks. Client satisfaction surveys Consumer Direction Can be consumer-directed. Other information Medicaid waiver program is part of the Home Care program but has separate functional eligibility criteria, MassHealth recipients are financially eligible.

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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