Personal Assistant

The purpose of this study was to describe the two ways in which Medicaid offers personal care services to low-income Americans: Medicaid Title XIX Personal Care Services (PCS) optional state plan benefit; and the Medicaid 1915(c) Home and Community-Based Services (HCBS) waivers program. A summary of the findings of this study are presented here as well as the article that appeared in the Health Care Financing Review, Summer 2001.

This fact sheet describes “Community First Choice Option” – one of the rules that the CMS recently released to expand access to home and community based services (HCBS) for people with disabilities. States that elect the Community First Choice option are eligible for a 6 percentage point increase in their federal medical assistance percentage. Individuals who require an institutional level of care are eligible for the services, which will be offered in community-based settings.

Program provides guidance for a three-year effort to use OSHA outreach & inspections to reduce specific occupational hazards in nursing & residential care facilities. The Department of Labor identified the following hazards: Exposure to blood & other potentially infectious material; Exposure to other communicable diseases; Ergonomic stressors related to lifting patients; Workplace violence; Slips, trips, and falls; Exposure to hazardous chemicals & drugs.

Risk factors associated with the incidence of recipient injuries, bedsores and contractures, and health care use among aged and non-aged adult personal care recipients are investigated. Data are from a statewide survey of aged and non-aged adult personal assistance service (PAS) recipients in California's In-Home Supportive Services (IHSS) program. Outcomes among recipients using relatives as paid providers are compared with those of recipients having non-relatives as providers.

Looking to better understand how states pay for adult day services through the Medicaid program? Comparing adult day services to other LTC provider types, adult day tends to be the most cost effective providers within the waiver or State Plan. This report looks at the scope of services provided by adult day and relates the clinical complexity of the care provided with the Medicaid reimbursement. Analyze the growth of programs in relation to the reimbursement and scope of services provided.

What are the factors that influence the kind of long-term services patients choose over time? This was examined through a study that interviewed individuals with LTC insurance policies over a two year period. Having someone available to assist when needed, and feeling safe were found to be the most important considerations. 93% responded that home care was their first choice, however 71 % indicated that there were no options for LTC other than nursing homes in their area.

Market approaches must become flexible with broader access to alternate providers and services such as HCBS. In the past, HCBS networks have been expensive to build and at times unwieldy to manage without sufficient dedicated resources. This presentation, which was delivered as the keynote for the September 2010 Medicaid Management Care Congress in Washington, DC., reviews the critical challenges to overcome for success in using HCBS as a strategy to extend care access.

Hiring relatives as caregivers remains a controversial policy issue. This two-state case study reports findings about views from policy experts regarding a policy option to hire family caregivers in HCBS long-term care programs. Policy makers also discussed information needed by other states considering this option and effective approaches to disseminate findings about this option from the Cash & Counseling Demonstration Evaluation.

States are curtailing optional services, extending waiting lists, cutting provider reimbursement, and taking other measures to cope with the worst economic downturn in 70 years according to a comprehensive 50 state survey. Even as state revenues shrink, the demand for services is increasing. On a brighter note, many states may participate in expanded HCBS services through ACA opportunities. Review preliminary findings presented at the National HCBS Conference in September, 2010.