April 4, 2005
HOME CARE FOR PEOPLE UNDER AGE 65
By: Robin K. Cohen, Principal Analyst
You asked (1) for a recent history of home health care assistance the state provides to individuals under age 65, including funding; (2) how other states provide this assistance; and (3) if the 2005 legislature is considering any bills in this area.
OLR Report 2004-R-0824 summarizes other states' home- and community-based services (HCBS) waiver programs, the primary means by which home care is offered to individuals under age 65. Additionally, we have attached a link to a Centers for Medicare and Medicaid Services (CMS) overview of states with HCBS waivers — http://www.cms.hhs.gov/medicaid/1915c/default.asp.
This report focuses on home and community-based services the Department of Social Services (DSS) provides, primarily to adults with physical disabilities. If you would like to know how other agencies (such as the Department of Mental Retardation) offer home care to their clients, please let us know. Children with special health care needs can receive some home care through the HUSKY Plus and Department of Public Health's Children with Special Health Care Needs programs.
You should also note that state law (CGS §§ 38a-493 and –520) mandates minimum insurance coverage for home health care in individual and group policies.
For many years the state has offered home health care to individuals with disabilities under the age of 65 using both state and Medicaid funds. The state has also provided non-medical home care services, such as personal care assistance (PCA), and other community-based services through Medicaid home- and community-based services waivers. These waiver programs provide a richer benefit package than traditional Medicaid, allowing many more people to stay out of institutions.
This session the Human Services favorably reported several bills to address a perceived need to offer more options for these individuals. These bills are currently in the Appropriations Committee.
DSS HOME CARE PROGRAMS FOR PEOPLE UNDER AGE 65 WITH DISABILITIES
Personal Care Assistance (PCA) Waiver
In 1995, the legislature directed DSS to seek a HCBS waiver to offer PCA services to individuals aged 18 to 64 who would otherwise require institutionalization. Since 1997, this consumer-directed program (the individual with disabilities must be able to hire and direct the assistant) has offered help to individuals whose income is not more than 300% of the federal SSI limit ($1,737 per month). But certain working adults with higher incomes can participate. Participants must need help with at least two activities of daily living. The waiver permits the program to accommodate up to 698 people.
According to Pam Giannini, director of DSS' Aging, Community Services, and Social Work Division, the waiver was recently amended to (1) cover a personal emergency response system; (2) allow 16-year -olds to be PCAs; (3) allow PCAs to work more hours, provided the employer (client) pays worker's compensation; and (4) allow additional hours to account for trips to the emergency room.
Estimated FFY 2004:
Average monthly caseload 485
Average monthly cost per client $ 1,735
Statutory Citation: CGS § 17b-605a
Acquired Brain Injury (ABI) Waiver
Also in 1995, the legislature directed DSS to seek an HCBS waiver to enable individuals with acquired brain injuries to remain in the community. (ABI is any combination of acquired focal and diffuse central nervous system dysfunctions, both immediate and delayed, at the brain stem level and above.) The income limit for the program is the same as for the PCA waiver.
The program, which has about 400 slots, currently offers 21 specific behavioral and support services to over 200 participants. An additional 204 people have applications pending with DSS.
FFY 2004 Actual
213 active clients
Average cost per client $63,194
Annual cost of waiver $13,460, 322
Statutory Cite: CGS § 17b-260a
Model (“Katie Beckett”) Waiver
Since 1983, this program has offered full Medicaid eligibility, case management, and home health care to people (primarily children) with severe disabilities who would otherwise require institutionalization who would not traditionally qualify based on the income of the participant's parent or spouse. The waiver itself offers only case management services, but families can avail themselves of full Medicaid benefits, including home health care and physical therapy. The benefits must be cost effective.
In 2000, the legislature increased the number of waiver slots from 125 to 200, but funding for the program limits the number of filled slots at 125.
We are still awaiting expenditure information on this program.
Regular Medicaid—Home Health Care
Outside the waiver programs, individuals can get Medicaid-covered home health care services if they meet the Medicaid program's regular eligibility requirements, which set income and asset limits significantly lower than they are in the waiver programs. (People enrolled in the waiver programs automatically qualify financially for regular Medicaid.)
A physician must authorize a cost-effective plan of care every 60 days. A client is allowed 12 skilled nursing visits per month and 20 hours of home health aide services per week after which he needs prior authorization for these services. (The governor's FY 06 budget recommends reducing these thresholds.) Once a Medicaid client reaches either of these limits, his entire care plan comes up for review, including home health, waiver services, and durable medical equipment.
FY 04 total spending:
$171,010,920 (includes $2,449,230 for physical, occupational, and speech therapies; $54,755,679 for medicine administration; and $50,970,606 for other services provided by RNs or LPNs)
Statutory Cite: CGS § 17b-242
Community-Based Services (CBS)
Even before the waiver program started, the state offered home care services using state funds. The CBS program, currently run by DSS, provides homemakers, companions, personal emergency response systems, and adult companions to individuals who have disabilities but are not eligible for the PCA program, primarily because they do not have the functional limitations that someone receiving PCA services must have. Services are capped at $650 per month.
Statutory Cite: CGS § 17b-605b
Current active caseload 1,387 (varies month to month)
Ave. cost per case $408 per month
Approximate annualized cost $6.5 million
Statutory Cite: CGS § 17b-283
2005 LEGISLATION ADDRESSING HOME HEALTH CARE FOR PEOPLE UNDER AGE 65
Human Services Committee
The Human Services Committee has considered several bills this session to address a perceived lack of community-based supports, including home health care, for individuals with disabilities under age 65. The committee favorably reported four of these to the Appropriations Committee: SB 1270, HB 6117, HB 6118, and HB 6880. HB 6786 (File 105) is on the House calendar.
SB 1270 directs the DSS commissioner to apply for a HCBS waiver to run a pilot program for home- and community-based services to people who (1) have tested positive for HIV or AIDS and (2) would be otherwise qualify for Medicaid-funded services in an institutional setting.
HB 6117 appropriates $2 million to DSS to fully-fund the model waiver program.
HB 6118 directs the DSS commissioner, in consultation with the commissioner of mental retardation, to apply for a federal Medicaid waiver to secure increased funds to home- and community-based supports for children and adults with developmentally disabilities who do not have a diagnosis of mental retardation, but who require specialized services in their homes and communities.
HB 6786 requires the policy and plan created by the Long Term Care Planning Committee to provide that individuals with long-term care needs have the option to choose the least restrictive, appropriate setting.
And HB 6880 requires the DSS commissioner to establish a state-funded pilot program to allow up to 50 people with disabilities between the ages of 18 and 64 who are inappropriately institutionalized, or at risk of such, to receive the same services that are provided under the state-funded portion of the Connecticut Home Care Program for Elders (CHCPE) provided they meet the financial eligibility requirements for that program. It also requires the commissioner to amend the existing CHCPE waiver to allow 50 adults under age 65 to participate, provided they meet all of the other program requirements.