Topic:
MEDICAID; ASSISTED LIVING; HOME CARE SERVICES;
Location:
HOME CARE SERVICES;

OLR Research Report


October 28, 2004

 

2004-R-0824

HOME AND COMMUNITY BASED CARE FOR ADULTS UNDER AGE 65

By: Robin K. Cohen, Principal Analyst

You asked which states have Medicaid waivers that permit them to offer home- and community-based services (HCBS), including self-directed personal care assistance (PCA) and attendant care, to adults under age 65.

SUMMARY

It appears that every state, except Nevada, and the District of Columbia offer home- and community-based care to adults under the age of 65 who have disabilities through federal HCBS waivers. Most of these states also offer PCA or attendant services, either as part of a range of home- and community-based services or as a separate HCBS waiver program.

This report includes those states that offer the range of services, including personal care assistance, to adults with disabilities (who are generally between the ages of 18 and 64) through federal HCBS waivers.

The report does not include waiver programs that target specific subgroups within the adults with disabilities population, such as adults with mental retardation, HIV/AIDS, or acquired brain injury. Many states, including Connecticut, have separate waiver programs for these populations. Let us know if you would like information on these programs.

It should also be noted that while many states have HCBS waivers, they serve a limited number of individuals. This is done in part to meet the federal government's rule that the waivers are cost-neutral, but also to allow states to control Medicaid costs.

For purposes of this report, PCA services are those that help individuals with activities of daily living during certain times of the day, while attendant services are those that an individual receives 24 hours a day, seven days a week. These terms are often used interchangeably.

MEDICAID WAIVERS

Home and Community Based Waivers—Section 1915(c) of the Social Security Act

In 1981, President Reagan signed into law Section 1915(c) of the federal Social Security Act, the Home and Community-Based Services Waiver program. Until that time, Medicaid's “institutional bias” meant that Medicaid would pay for long-term care only when it was provided in institutional settings. Since then, most states have used the waiver to create more appropriate, less costly alternatives for their elderly and disabled populations. For adults under 65, these programs generally combine medical and non-medical services in a community based setting. Sometimes, they include PCA or attendant care, where the individual hires someone directly to help with activities of daily living, such as bathing and dressing.

Table 1 shows the states that have HCBS waivers for these adults and which of these include PCA or attendant services, either as part of a larger service package or as a separate waiver program.

Table 1: State Medicaid HCBS Waivers for Adult

Under-65 Populations

State

Home- and Community-Based Waiver

PCA and Attendant Care Included

Alabama

Yes

Yes

Alaska

Yes

No

Arkansas

Yes

Yes

California

Yes

Yes

Colorado

Yes

Yes

Connecticut

Yes

Yes [1]

Delaware

Yes

Yes

-Continued-

State

Home- and Community-Based Waiver

PCA and Attendant Care Included

District of Columbia

Yes

Yes

Florida

Yes

Yes

Georgia

Yes

Yes

Hawaii

Yes

Yes

Idaho

Yes

Yes

Illinois

Yes

Yes

Indiana

Yes

Yes

Iowa

Yes

Yes

Kansas

Yes

Yes

Kentucky

Yes

Yes

Louisiana

Yes

Yes

Maine

Yes

Yes

Maryland

Yes

Yes

Massachusetts

Yes

No

Michigan

Yes

Yes

Minnesota

Yes

Yes

Missouri

Yes

Yes

Mississippi

Yes

Yes

Montana

Yes

Yes

Nebraska

Yes

No

Nevada

No

NA

New Hampshire

Yes

Yes

New Jersey

Yes

Yes

New Mexico

Yes

Yes

New York

Yes

No

North Carolina

Yes

Yes

North Dakota

Yes

Yes

Ohio

Yes

Yes

Oklahoma

Yes

Yes

Oregon

Yes

Yes

Pennsylvania

Yes

Yes

Rhode Island

Yes

Yes

South Carolina

Yes

Yes

South Dakota

Yes

Yes

Tennessee

Yes

Yes

Texas

Yes

Yes

Utah

Yes

Yes

Vermont

Yes

Yes

Virginia

Yes

Yes

West Virginia

Yes

No

Washington

Yes

Yes

Wisconsin

Yes

Yes

Wyoming

Yes

Yes

Source: Centers for Medicare and Medicaid Services (2003, 2004 reports)

[1] Connecticut has a “stand-alone” HCBS waiver for PCA services for people with disabilities under age 65. Other HCBS services for this population are provided under state-funded programs.

RC:ts