Home- and community-based services beyond Medicaid: how state-funded programs help low-income adults with care needs live at home
- Collection:
- Health Policy and Services Research
- Author(s):
- O'Brien, Ellen, author Fox-Grage, Wendy, author Ujvari, Kathleen, author
- Contributor(s):
- AARP (Organization), issuing body. Commonwealth Fund, issuing body. SCAN Foundation, issuing body. Public Policy Institute (AARP (Organization)), issuing body.
- Publication:
- Washington, DC : AARP Public Policy Institute, February 2019
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Community Health Services Home Care Services Long-Term Care Aged Health Services Needs and Demand Caregivers Cost Sharing Eligibility Determination Financing, Government Needs Assessment State Government Humans United States
- Genre(s):
- Technical Report
- Abstract:
- People with low incomes who need home- and community-based services (HCBS) may not receive assistance from Medicaid because of a state's clinical and financial eligibility criteria. However, adults with significant needs for assistance can find themselves on a path to Medicaid, especially when family caregivers are unable to provide all of the assistance required, or when paying for services drains the financial resources of the person needing support. Roughly 6 out of 10 (62 percent) nursing home residents rely on Medicaid, often because they have spent their funds paying for care. Many states have sought to lower these risks by establishing one or more general revenue– funded programs designed to provide modest assistance to low-income people who are not enrolled in Medicaid, to address unmet needs, prevent adverse events, and improve well-being. These programs also are intended to help adults use their resources effectively to maintain their community residence, and delay or prevent out-of-home placement and spend down to Medicaid. This paper is part of a series on promising practices and emerging innovations from the 2017 Long-Term Services and Supports State Scorecard. The Scorecard includes state-funded HCBS programs as an indicator of a high-performing long-term services and supports (LTSS) system because these programs can be used to reach the near poor--who may not yet qualify for Medicaid--to prevent impoverishment and more expensive nursing home care. The Scorecard found that most states provide some non-Medicaid state funding for HCBS. While some states have made significant investments, funding is typically very small and limited compared with Medicaid. We interviewed state administrators and reviewed program documents to provide a profile of programs in nine states: Connecticut, Illinois, Massachusetts, Nebraska, New Jersey, North Dakota, Oregon, Pennsylvania, and Washington. The programs--which rely on state general fund revenues and sometimes additional sources of funding, such as lottery revenues and federal Social Services Block Grants--are designed to support low-income older adults and adults with physical disabilities at home. Most programs were started decades ago, when Medicaid was still a relatively young program that emphasized nursing home care. In addition, the paper highlights Washington state's emerging innovation: the Medicaid Transformation demonstration, which tailors support for near poor older adults and family caregivers. The design, operation, and outcomes of these programs can provide useful insights for federal and state policy makers. Note: This paper focuses on state-funded programs for older adults and adults with physical disabilities, not other populations that require LTSS, such as individuals with behavioral health needs or intellectual/developmental disabilities. We are grateful to the state administrators who provided program insights as well as enrollment and spending data.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (iv, 28 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101753876 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101753876