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

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: The Homemaker Program⁴,³⁸

Administrative Agency: Dept of Aging & Disabilities

Population Served: Elderly & Physically disabled adults.

Annual Expenditure: $801,741 FY02 Appropriation

Funding Source: General revenue, clients contribute + Federal funds (SSBG)

Number of People Served: 851 FY02

Eligibility Criteria: People who need assistance with 1/more ADLs &/or have cognitive impairment. No income or asset limit.

Further Information: Cost control Co-pay on a sliding scale.

Program Name: Attendant Services Program: (a) Participant Directed Attendant Care & (b) Personal Services⁴,³⁸

Administrative Agency: Dept of Aging & Disabilities

Population Served: Elderly & Physically disabled adults.

Annual Expenditure: $3,448,283 FY02

Funding Source: General Revenue

Number of People Served: 186 FY02

Eligibility Criteria: Participant Directed Attendant Care People with a severe & permanent physical disability & need assistance with 2/more ADLs. No income or asset limit Personal Services People requiring support with at least 1 ADL or meal preparation & are Medicaid eligible. No income or asset limit

Further Information: Consumer direction Participant Directed Attendant Care: Service users hire, train & supervise their attendant provider. Spouses or civil union partners can be employed in this role. Personal Services: An agency can be employed to direct the attendant if the client doesn't want to do it themselves. A spouse or civil partner may be employed. Other information Another state-only program has legislative approval, should funding become available. The Group directed Attendant Care Program is part of the Attendant Services Program.

Program Name: Housing & Supportive Services Program⁴,³⁸

Administrative Agency: Dept of Aging & Disabilities

Population Served: Elderly 60+ & Physically disabled adults

Annual Expenditure: $550,000 FY02

Funding Source: General revenue

Number of People Served: 713 FY02

Eligibility Criteria: Individuals in congregate housing settings 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. Income limit varies. No asset limit.

Further Information: Cost control: No cost caps. No service limits applied. Co-pay on sliding fee scale or suggested donation (varies by site). Consumer direction Can be consumer directed. Quality control: quality outcomes, client satisfaction survey. Other information Coordinates access to existing services & last resort to finance services for people at risk of institutionalization.

Program Name: Adult Day Services⁴

Administrative Agency: Dept of Aging & Disabilities

Population Served: Elderly 60+, disabled

Annual Expenditure: $1,038,786 FY02 Appropriation

Funding Source: General Revenue & clients contribute

Number of People Served: 978 FY02

Eligibility Criteria: Each day center defines its own income and asset limits & sliding fee scale.

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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