Home- and Community-Based Services Beyond Medicaid: How …€¦ · need lower levels of care at home to live in the community than those in the Medicaid Personal Assistance Services

AARP PUBLIC POLICY INSTITUTE FEBRUARY 2019

Promising Practices and an Emerging Innovation

Ellen O’Brien, PhDIndependent Consultant

Wendy Fox-Grage and Kathleen UjvariAARP Public Policy Institute

Home- and Community-Based Services Beyond Medicaid: How State-Funded Programs Help Low-Income Adults with Care Needs Live at Home

ii HOW STATE-FUNDED PROGRAMS HELP LOW-INCOME ADULTS WITH CARE NEEDS LIVE AT HOME

AARP PUBLIC POLICY INSTITUTE

HOW STATE-FUNDED PROGRAMS HELP LOW-INCOME ADULTS WITH CARE NEEDS LIVE AT HOME iii

PROMISING PRACTICES AND AN EMERGING INNOVATION

Table of Contents

ABOUT THIS PAPER ..................................................................................................................................................iv

PURPOSE ......................................................................................................................................................................... 1

FINDINGS ........................................................................................................................................................................3Mission ....................................................................................................................................................................4Needs Assessment ................................................................................................................................................5Financial Eligibility and Cost Sharing ............................................................................................................6Benefits and Care Planning ...............................................................................................................................7Family Caregivers ................................................................................................................................................8Financing ................................................................................................................................................................9Outcomes .............................................................................................................................................................. 11

CONCLUSION: STRENGTHENING HCBS PROGRAMS ...............................................................................12

APPENDIX. HCBS PROGRAMS IN NINE STATES: PROGRAM ELEMENTS ......................................13

LIST OF EXHIBITSExhibit 1 Brief Descriptions of HCBS Programs ................................................................................................... 1

Exhibit 2 Size of HCBS Programs That Serve Low-Income Adults with Care Needs .................................3

Exhibit 3 Oregon Project Independence’s Strategy for Managing Limited Resources ................................6

Exhibit 4 Washington State’s Emerging Innovation: Medicaid Transformation Demonstration to Tailor Supports for Near Poor Older Adults and Family Caregivers .....................................10

iv HOW STATE-FUNDED PROGRAMS HELP LOW-INCOME ADULTS WITH CARE NEEDS LIVE AT HOME


About This PaperPeople 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.

* Ari Houser, Wendy Fox-Grage, and Kathleen Ujvari, Across the States, Profiles of Long-Term Services and Supports, 2018 (Washington, DC: AARP Public Policy Institute, August 2018), http://www.aarp.org/acrossthestates.

** To varying degrees, states help connect older adults and family caregivers to community services, such as assistance with meals, transportation, family caregiver respite services, and care management, often delivered by Area Agencies on Aging with Older Americans Act funding.

*** Susan C. Reinhard, et al., Picking Up the Pace of Change. A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers (Washington, DC: AARP Public Policy Institute, June 2017), http://www.longtermscorecard.org.

HOW STATE-FUNDED PROGRAMS HELP LOW-INCOME ADULTS WITH CARE NEEDS LIVE AT HOME 1


Purpose

This Promising Practices paper highlights examples of how state-funded HCBS programs are supporting low-income older adults and/or people with physical disabilities and their family caregivers to live with maximum independence at home (exhibit 1). See the appendix for more

detailed information. This paper aims to help administrators, policy makers, and advocates learn from each other and implement programs that will reach people who do not qualify for Medicaid or who are waiting to receive Medicaid services.

STATEPROGRAM AND STARTING YEAR DESCRIPTION

Connecticut Connecticut Home Care Program for Elders, 1987

Provides a wide range of services (11 types) to adults ages 65+ to live at home, in an adult foster care home, or in some assisted living facilities and avoid nursing home placement. Enrollees must have low assets. There is income-related cost sharing but no income limit for eligibility.

Illinois Community Care Program, 1979

Provides a range of services, including adult day services, emergency home response services, and in-home services, to delay or prevent nursing home placement for adults ages 60+ who need or at risk of needing this level of care. Enrollees must have low assets and participate in cost sharing according to income.

Massachusetts Home Care Program, 1973

Also called the basic program, to distinguish it from the enhanced program, it provides a wide range of services (25 types) to adults ages 60+ (or younger adults with a diagnosis of Alzheimer’s disease or a related disorder) to maintain maximum independence in their home environment. Eligible adults who are low income must pay income-related monthly copayments. Adults who are over income may qualify for home care and respite care services and have additional cost-sharing requirements.

Enhanced Community Options Program, 1993

Provides enhanced home care services to people with a higher level of need (i.e., who meet nursing home level of care), who do not qualify for standard Medicaid. Financial eligibility is the same as for the Home Care Program. This program is not available to adults determined over income who are found eligible for the home care and respite over income programs.

Nebraska Care Management, 2008

Provides information, referral, and care management for adults ages 60+.

Lifespan Respite, 2002 Provides or funds respite care for family caregivers of individuals who are not eligible for any other government-funded respite care.

Social Services for Aged and Disabled Adults, 1973

Provides a range of HCBS to older adults or adults with disabilities who need lower levels of care at home to live in the community than those in the Medicaid Personal Assistance Services program.

New Jersey Jersey Assistance for Community Caregiving, 2000

Provides 14 types of HCBS to adults ages 60+ who meet nursing home level of care. Clients may reside at home or in the home of a relative or friend. Income and asset limits apply, and income-related copayments are required. Monthly cost caps apply.

EXHIBIT 1Brief Descriptions of HCBS Programs

2 HOW STATE-FUNDED PROGRAMS HELP LOW-INCOME ADULTS WITH CARE NEEDS LIVE AT HOME


STATEPROGRAM AND STARTING YEAR DESCRIPTION

North Dakota Service Payment for the Elderly and Disabled (SPED), 1983

Provides 13 types of HCBS for people who are older or physically disabled and who have difficulty completing tasks that enable them to live independently at home. An asset limit applies, and income determines a recipient’s cost share based on sliding fee schedules.

Expanded Service Payment for the Elderly and Disabled, 1994

Similar to SPED, but it is targeted to low-income older individuals who may require some assistance with activities of daily living but whose primary need is for help with instrumental activities of daily living or supervision at home or in a structured environment (e.g., adult foster care).

Dementia Care Services, 2010

Provides care, consultation, and training to family caregivers to address individual needs that arise during dementia.

Oregon Oregon Project Independence, 1975

Provides individuals ages 60+ or younger adults with Alzheimer’s disease (and younger adults with disabilities in a 2005 pilot) with in-home services to promote self-determination and aging in place. Services include personal care, homemaker, adult day care, care management, and home-delivered meals. There are no income or asset limits for eligibility. Clients with income above 150% of the federal poverty level (FPL) pay income-related cost sharing (100% of costs are paid by clients with income > 400% of FPL).

Pennsylvania OPTIONS, 1990 Provides consumers ages 60+ with a range of HCBS to assist them in maintaining independence with the highest level of functioning in the community and to delay the need for more costly services. Area Agencies on Aging operate the program. Local agencies must offer four required services and may offer additional optional services. Enrollees with income between 133% and 300% of FPL pay income-related cost sharing.

Caregiver Support Program, 1990

Provides financial assistance to primarily qualified caregivers who assist dependent low-income older adults.

Washington* Medicaid Alternative Care (MAC), 2017

Supports unpaid family caregivers caring for adults ages 55+, who are eligible for Medicaid, and who meet nursing home level of care. Provides caregiver assistance services such as housework, transportation, respite, and home-delivered meals; caregiver training; adult day health; and personal emergency response.

Tailored Supports for Older Adults (TSOA), 2017

Provides seven types of HCBS to individuals ages 55+ and their family caregivers with low income and limited assets, who currently do not meet Medicaid financial eligibility criteria but have been deemed at risk of becoming Medicaid eligible. Person-centered care planning is used to identify participants’ and unpaid caregivers’ needs.

Family Caregiver Support Program, 1989

Provides services to unpaid caregivers who provide supports to adults, using evidence-based TCARE® to assess the burdens, stresses, and uplifts that caregivers experience and to guide the choice of interventions, such as training/education, counseling, respite, equipment/supplies, and wellness therapies.

Senior Citizens’ Services Act, 1977

Provides older individuals, regardless of income, with in-home HCBS to help them stay in their own homes, to promote self-determination and aging in place. Limited state funding is used to overmatch Older Americans Act funding. Service offering is designed at the local level.

* Unlike the other programs in this paper, the Washington MAC and TSOA programs are provided under an 1115 Medicaid demonstration waiver and use 100 percent federal funds. They are included in this paper because these programs serve near poor older adults and family caregivers who are not in the traditional Medicaid program. We consider this waiver demonstration to be an emerging innovation.



Findings

The design of state-funded HCBS programs varies across states, but most provide care management and direct services to people who need assistance to remain independent in the community. Programs share features such as standardized needs assessment, care management, cost sharing,

spending caps, and substantial discretion for care managers to decide how to spend available resources. Across states, programs vary widely in size because of differences in the population to be served and the amount services provided (exhibit 2).

STATE PROGRAM

ENROLLEES(MOST RECENT ENROLLMENT

DATA AS OF 2017)

AVERAGEMONTHLY

EXPENDITURE(OR CAP)

Connecticut Connecticut Home Care Program for Elders 2,750 $715Illinois* Community Care Program (CCP) About 54,000 $983Massachusetts Home Care Program 31,504 NA

Enhanced Community Options Program 9,843 NAHome Care Over Income About 500 NARespite Care Over Income 5,731 NA

Nebraska Care Management 4,151 NALifespan Respite 949 Capped at $125/month;

$1,000/year for exceptional need

Social Services for Aged and Disabled Adults 4,049 Congregate meals: $54Adult day: $228

Home chores: $140Transportation: $127

New Jersey Jersey Assistance for Community Caregiving 2,153 Capped at $600/month North Dakota Service Payment for the Elderly and Disabled

(SPED)1,025 $494

Expanded SPED 140 $408Dementia Care Services 1,838 NA

Oregon Oregon Project Independence 2,099 $332Pennsylvania OPTIONS 67,463 $765

Caregiver Support Program 5,256 $200Washington** Medicaid Alternative Care (MAC) 63 dyads About $350 (capped at $3,438

for 6 months)Tailored Supports for Older Adults (TSOA) 675 dyads

1,735 individuals without a caregiver

About $350 (capped at $573/month)

Family Caregiver Support Program 5,460 dyads $358Senior Citizens’ Services Act About 6,000 NA

NA = Not Available

* As of September 2018, total aging participants were 107,908 (30,733 with a Medicaid managed care organization, 39,251 on CCP and Medicaid, and 37,924 on CCP and non-Medicaid). Roughly half of the total clients are non-Medicaid. Source: Email communication with Jose Jimenez, Illinois Department of Aging, December 10, 2018.

** Given Washington’s new MAC and TSOA programs, the numbers representing the first year of enrollment do not reflect what the cost per person will be over the lifetime of the waiver. Some individuals access the program for one-time services while others receive services on a monthly basis. Enrollment is increasing by 40–100 clients per month. Source: Email and phone interview communications with Washington Aging and Long-Term Support Administration, October 2018.

EXHIBIT 2Size of HCBS Programs That Serve Low-Income Adults with Care Needs



MISSIONState-funded HCBS programs provide services and supports to help low-income, older adults and people with physical disabilities live at home. Services may be provided to both the care recipient and their family caregivers, with the goals of improving quality of life for those who need assistance, reducing burdens on family caregivers, and decreasing nursing home utilization and spending down to Medicaid eligibility. These services can be provided much quicker than in the traditional Medicaid programs because the Medicaid eligibility process often takes several months.

Adults with physical and cognitive impairments may need assistance with self-care activities (e.g., eating, showering, getting to the toilet, dressing); with household activities (e.g., doing laundry, shopping for groceries, preparing meals, keeping track of medication); with mobility (e.g., getting out of bed, getting around inside the home, getting outside the home); and with complex medical/nursing tasks. Some may receive all the assistance they need from family members and friends. Others may receive some assistance but not all the assistance they need when family caregivers, for example, are unavailable because of work and other demands. Older adults and adults with physical disabilities with unmet needs for assistance are at risk of adverse health consequences, diminished quality of life, and out-of-home placement.

These state-funded HCBS programs typically serve adults ages 60 and older and/or younger adults ages 19–59 with disabilities (and their family caregivers) who have assessed needs for assistance. They are part of a strategy to decrease reliance on nursing homes and support community living through the cost-effective use of public and private resources. For example, in Nebraska, citizens who are ages 60+ or between the ages of 19 and 59 with a disability can receive a limited range of HCBS—such as

1 The level of care requirements for Medicaid nursing home care vary widely across states. States use comprehensive assessments of functional needs, medical conditions, cognitive impairment, and social support needs to determine eligibility. At the most general level, individuals who are unable to care for themselves for a sustained period of time and who would be at risk of harm without substantial assistance may meet the clinical eligibility criteria for nursing home admission under Medicaid.

meals, home services, adult day service, personal care, and transportation—in its Social Services for Aged and Disabled Adults program. This program offers two basic types of supportive services: those targeted to individuals who need care and to their primary family caregivers. North Dakota’s Expanded Service Payment for the Elderly and Disabled program pays for in-home and community-based services for older adults ages 60+ or adults ages 19–59 with disabilities who would otherwise receive care in a licensed basic care facility. These individuals usually require assistance with tasks such as meal preparation, housework, laundry, or medication management.

Because the goal of these programs is to support adults at home, people living in an assisted living facility or another residential care setting typically are not eligible for assistance. In Oregon, any individual who resides in a nursing facility, assisted living facility, residential care facility, or adult foster home setting is not eligible for Oregon Project Independence services.

Clinical eligibility varies across states. Some states target adults with significant disabilities who are eligible for nursing home care under Medicaid. For example, Illinois and New Jersey offer services to older adults who meet the clinical eligibility guidelines for Medicaid nursing home care in the state.1 Other state programs offer services more broadly, including adults with lower levels of functional impairment and more modest needs for assistance. Because the goal is to reduce nursing home placement, states use various strategies to target the population most at risk of a nursing home placement.

In Massachusetts, the state-funded Enhanced Community Options program provides assistance to people who are clinically eligible for nursing home care (requiring at least one skilled nursing or therapy visit daily or requiring



a nursing service at least three times per week plus two other services for activities of daily living [ADLs]). In addition, the state’s basic Home Care Program provides services on a less frequent basis to older adults who need some assistance with daily activities but who do not meet the clinical eligibility threshold for nursing home care. To qualify for any of the home care programs, older adults must require assistance with at least one ADL and have a critical unmet need for assistance (unmet need for assistance with any ADL, meal preparation, food shopping, home health services, medication management, respite care, or transportation for medical treatments).2

In Connecticut, people who meet a nursing home level of care (three or more critical needs) are eligible for a higher level of service than those who are at risk of nursing home placement but with lower needs (one to two critical needs).

NEEDS ASSESSMENTStates use a needs assessment for eligibility determination and care planning. Services are targeted to adults who require assistance to live at home and who have critical unmet needs.

In all states, community-based agencies are essential to effective service delivery. Programs typically are administered at the state level by the Aging Division within the state’s Department of Human Services and managed at the sub-state level by Area Agencies on Aging (AAAs) or other nonprofit social service agencies that are contracted to provide assessment, eligibility determination, and care management. For example, in Massachusetts, the Home Care Program is operated by 26 Aging Services Access Points (ASAPs). ASAPs are private, nonprofit agencies with governing boards (appointed by local Councils on Aging) that are made up of at least 51 percent representation

2 Critical unmet needs are distinguished from noncritical unmet needs, which include one or more of the following: laundry, housework, shopping other than food shopping, transportation other than transportation for medical treatment, socialization, and telephone use. See Massachusetts Home Care Program regulations, 651 CMR 3.00: Home Care Program, https://www.mass.gov/files/documents/2017/10/19/651cmr3.pdf.

of people ages 60 and older. ASAPs provide information and referral, interdisciplinary case management (intake, assessment, development, and implementation of service plans), service plan monitoring and needs reassessment, and protective services (investigations of abuse, neglect, and self-neglect of elders).

Similarly, in Illinois, the state contracts with 48 Care Coordination Units (CCUs), independent nonprofit organizations that serve as central access points for older adults with LTSS needs. CCUs are typically not-for-profit agencies or a governmental entity, such as a local public health department. These units cannot deliver services in the same areas in which they provide assessment and case management services. CCU care managers evaluate the need for LTSS using a standardized needs assessment instrument—the Determination of Need. In addition to initial intake and assessment responsibilities, care managers write plans of care, arrange for the implementation of services, perform needs reassessments (at least annually), and provide ongoing care management to program beneficiaries.

In North Dakota, by contrast, the program is operated by local governments through county offices of social services. In many states, the assessment and care planning for people seeking assistance from Medicaid is conducted by the entity responsible for enrollees in the general revenue–funded program.

Care managers use a standardized assessment to evaluate an individual’s assistance needs, the assistance they currently receive from family caregivers, and their unmet needs. In general, state-funded HCBS programs seek to deliver services to (a) people who lack family support or those whose family caregivers need assistance, and (b) people who have limited financial resources. States use a variety of strategies to use



needs assessments to target limited resources in state-funded HCBS programs (exhibit 3).

The need for assistance with ADLs is the criterion used most commonly to assess functional eligibility for HCBS. Other assessment criteria include the need for assistance with instrumental activities of daily living (IADLs); the presence of medical conditions; cognitive impairment; the need for a minimum number of hours of assistance; and unmet needs for assistance with critical supports such as medical needs, cognitive or memory issues, behavioral issues, and functional needs. The assessment (and eligibility thresholds) may be the same as those used for nursing facility screening in the state.

For example, in the Massachusetts Home Care Program, an interdisciplinary team of care managers and nurses from ASAPs conducts a Long-Term Care Assessment in the person’s home to determine eligibility for the programs. The assessment measures the degree of functional impairment experienced by an applicant or consumer as evidenced by an inability to complete ADLs and IADLs. This assessment is used to determine eligibility for services and care planning and is completed periodically thereafter to assess a consumer’s needs for Home Care Program services.

FINANCIAL ELIGIBILITY AND COST SHARINGPrograms target low-income people at risk of nursing home admission and of spending down to Medicaid. With the exception of people living in or near poverty, enrollees usually are required to contribute to care plan costs.

State-funded programs are targeted to very low-income people with limited financial resources (savings or other liquid assets). Programs generally pay for services only when there are no other available sources of support (e.g., Medicare-funded home health care, private long-term care insurance, informal supports). Many states require individuals who appear to be eligible for Medicaid to apply for Medicaid, to reduce the burden on state spending. Some states also apply Medicaid’s estate recovery rules for services received under a state-funded HCBS program.

In Illinois, older adults are eligible to receive Community Care Program (CCP) services if they are at least 60 years of age, have no more than $17,500 in nonexempt assets, and are determined in need of LTSS. CCP clients can be Medicaid or non-Medicaid eligible. Non-Medicaid clients may have a copayment for services received depending on their income level. Medicaid enrollees do not have a copayment.

EXHIBIT 3Oregon Project Independence’s Strategy for Managing Limited Resources

The goal of the Oregon Project Independence program is to serve those who are the most functionally impaired and who have no (or inadequate) alternative service resources. Priority is given to frail and vulnerable older adults who lack sufficient access to other LTSS and who are the most at risk for out-of-home placement. Almost half of those who are screened for the program need help with at least two ADLs, such as bathing, dressing, or walking. More than 65 percent intend to remain at home and do not wish to move to a higher level of care.

Program administrators seek to manage limited resources to enable the greatest number of people to receive needed services. Oregon’s model uses service priority levels, which are categories that indicate a person’s need for assistance when receiving state- and federal-funded services. Levels range from Level 1, which reflects the most impaired, to Level 18, which reflects the least impaired. The current average service priority level for program enrollees is 12.



Massachusetts’s Home Care Program assesses a flat, income-related copayment of $10 to $141 (for an individual in 2017). In the over income programs, enrollees pay income-related cost sharing of 50–100 percent of costs. Copayment adjustments may be considered owing to high consumer expenses related to medical care or traumatic events, such as weather-related events. New Jersey also has flat monthly copayments.

Fees for Oregon Project Independence in-home services are charged based on a sliding fee schedule determined by the AAA. Individuals with net incomes below 150 percent of the Federal Poverty Level (FPL) have a one-time fee; those between 150 and 400 percent of FPL are expected to pay a fee (of 5–90 percent of their service costs) toward their service. Clients with net incomes above 400 percent of FPL pay the full hourly rate for the service provided.

In Connecticut, the state-funded program has no income limit. People with more assets than the Medicaid limit, but not unlimited assets, can qualify for state-funded home care. The asset limit for an individual is 150 percent of the minimum amount that a community spouse could have under Medicaid ($35,766 in January 2016). Clients pay a 9 percent cost share each month based on paid claims data for that month.

In Pennsylvania’s OPTIONS program, clients pay on a sliding fee scale, with clients above 300 percent of FPL paying the full cost. Clients are required to apply for Medicaid if they are close to financial eligibility.

BENEFITS AND CARE PLANNINGHCBS programs include a wide range of services, with care management as a core service. Care planners typically have wide discretion to authorize whatever services can cost-effectively support adults with care needs in the manner they prefer.

A wide range of services may be authorized, including services to provide assistance with self-care, household activities, and mobility. Commonly provided services include care coordination, homemaker, chore, personal emergency response,

adult day health, home-delivered meals, and respite services. In most programs, care managers meet with older adults, adults with physical disabilities, and family caregivers before developing a care plan, to assess their needs, their current sources of support, and their unmet needs for assistance.

In Illinois, for example, the CCP provides older adults with case management services to help them determine what their specific needs are and what services are available to meet those needs. Service plans can include home services—such as assistance with cleaning, doing laundry, shopping, running errands, and preparing and planning meals, and assistance with personal care tasks such as dressing, bathing, and grooming—as well as adult day services.

In Massachusetts, care managers can authorize adult day health care, Alzheimer’s/dementia coaching, behavioral health services, chore services, companion services, food shopping, home health aides, homemaker services including laundry, meal delivery, meal planning and preparation, medication assistance, minor home repair and yard work, nutritional counseling, personal care services, personal emergency response services, respite care, and transportation assistance.

Benefits are more limited in some state programs. In the Nebraska Care Management program, for example, care management is the primary benefit offered to assist individuals ages 60+ with coordinating in-home and community-based care.

In establishing a care plan, care managers must arrange for services that can be paid for within a monthly cap on program expenditure per client. In many states, benefit maximums are the same for all enrollees regardless of need. In Washington’s Tailored Supports for Older Adults, service costs are capped at $573 per month. In the Nebraska Lifespan Respite program, family caregiver support is capped at $125 per month and $1,000 per year for exceptional needs. Because of the limited dollar amounts, families can bank the respite subsidies for months and then use them for adult day services or camps.



In some programs, however, per-enrollee budgets vary by level of need, with higher budgets authorized for people with greater needs. For example, in Illinois, budgets (service cost maximums) rise with level of need as measured by the state’s Determination of Need assessment.3 In Connecticut, care plan service cost limits are set as a percentage of average nursing home costs, with higher caps for enrollees with greater needs. Category 1 clients are eligible for limited home care plans that cost less than 25 percent of nursing home costs (i.e., a cap of $1,445 per month). Category 2 clients for frail older adults with some assets above Medicaid limits have a care plan cost cap of 50 percent of nursing home costs ($2,889 per month).

Several programs allow care managers to authorize expenditures that exceed the monthly budget caps when necessary (e.g., for home modifications to enable aging in place). In Illinois, the state expanded CCP services to include emergency home response as a core service and funding to allow for home modifications, such as wheelchair ramps, grab bars, and other home improvements, to further prevent aging older adults from turning to premature nursing home entry because of gaps in community-based LTSS.4 Some programs allow for additional expenditures when needs rise, such as when needs for assistance are greater after a hospitalization.

FAMILY CAREGIVERSThe preservation of family caregiving is an important component of these state-funded programs.

Several state departments on aging administer state-funded family caregiver programs that are funded outside the federal National Family

3 Some concerns have been raised about whether the level of resources available to people with the highest level of need are adequate to meet their needs for assistance in the community.

4 Finance Workgroup of the Illinois Older Adult Services Advisory Committee, How Long-Term Care Services for Seniors Are Currently Financed in Illinois (Springfield, IL: Illinois Department on Aging, June 2007), https://www2.illinois.gov/aging/CommunityServices/Documents/finance.pdf.

5 Lewin Group, Process Evaluation of the Older Americans Act Title III-E National Family Caregiver Support Program: Final Report, prepared for the Administration for Community Living, (Falls Church, VA: Lewin Group, March 2016), https://acl.gov/sites/default/files/programs/2017-02/NFCSP_Final_Report-update.pdf.

Caregiver Support Program. Many of the departments began these programs before the inception of the National Family Caregiver Support Program in the Older Americans Act,5 which was established in 2000 to provide grants to states and territories to help family caregivers care for their family members at home. These state-funded family caregiver support programs also can provide services to younger clients who would not qualify under the Older Americans Act.

In many state-funded HCBS programs, care planning includes an explicit assessment of the support and assistance provided by family caregivers and other informal supports. Their roles and contributions are assessed and included in the care plan, so that services preserve and support family caregiving, rather than reduce family caregivers’ contributions. This assessment of the family caregiver is part of the strategy pursued by most states to target resources based on needs.

Oregon, for example, identifies natural supports, meaning resources and supports (e.g., relatives, friends, significant others, neighbors, roommates, the community) who are willing to voluntarily provide services to an individual without the expectation of compensation. Natural supports are identified in collaboration with the individual and the potential natural support. The natural support is required to have the skills, knowledge, and ability to provide the needed services and supports.

In Massachusetts, care managers assess consumers’ needs and provide service plans that meet their needs, by incorporating family caregiver supports and other available resources and utilizing the home care–funded benefits as part of the service plan.



Providing support to family caregivers, especially in rural areas, is important for some of these state-funded programs. In sparsely populated places, people in need of care face a lack of nearby providers, grocery stores, and pharmacies, which is particularly hard for people who do not drive and their family caregivers.

The Nebraska Lifespan Respite Program serves individuals of any age with a special need who live with an unpaid family caregiver in a noninstitutional setting; it also provides limited respite care to give these caregivers a break from the ongoing demands.

In North Dakota, both the Service Payment for the Elderly and Disabled and the Expanded Service Payment for the Elderly and Disabled programs cover a wide range of services and may pay family caregivers, including a spouse. Under its Family Home Care benefit, the program may reimburse a family caregiver who meets the relationship requirements defined by state law and who resides in a client’s home 24 hours per day. The state’s Dementia Care Services program provides care consultation and training to family caregivers who are caring for someone with dementia.

Pennsylvania’s Caregiver Support program provides financial assistance to qualified caregivers who assist dependent low-income older adults. The program also supports individuals ages 55 and older who care for related children.

FINANCINGBecause general revenue–funded HCBS programs compete with other state needs and priorities, they are often at risk when policy makers want to or must reduce program spending, shift resources to other priorities, or close budget gaps. Alternative financing strategies—such as dedicated revenues (e.g., from tobacco taxes, lottery revenues, taxes

6 Legislative Committee Services, “Seniors, People with Disabilities, and Long-Term Care Services,” Background Brief, (Salem, OR: Legislative Committee Services, September 2012), https://www.oregonlegislature.gov/lpro/Publications/SeniorsDDLongTermCare.pdf.

7 The entitlement resulted from a court case that was brought against the state to eliminate waiting lists for services. In 1982, the Department on Aging received an order from the US District Court in Benson vs. Blaser. The class action suit focused on the lengthening waiting list for community-based services for older adults. The court ruled that people on the waiting list were as entitled to timely determination of eligibility and receipt of services as beneficiaries who applied earlier, when no waiting list existed.

on casinos) and federal Medicaid matching payments—can help ensure adequate funding.

The level of state funding—and its stability over time—determines how many adults can receive services and the level of assistance they can receive. State HCBS programs are general revenue–funded and operate with fixed budgets. Because HCBS programs compete with other state needs and priorities, they are often at risk of budget cuts. State legislatures make annual (or biennial) appropriations for services and administrative operating costs of the programs, often informed by recommendations from the administrative agency as well as public hearings and comments.

Oregon Project Independence recently has been subject to substantial budget uncertainty. Although it ultimately was funded, the threat of defunding undermined program operations and may have deterred families from seeking assistance, causing enrollments to decline. Several years ago, enrollments also declined (from 2,166 in 2010 to 1,583 in 2011) and wait lists expanded (to 406 individuals) when program funding was reduced.6

Many of these programs are small and are underfunded relative to needs. In Connecticut, the Home Care Program for the Elderly is closed to new enrollees who are moderately frail and at risk of hospitalization or short-term nursing home placement (e.g., Category 1). In New Jersey, the Jersey Assistance for Community Caregiving program budget has not changed since its inception—with funding of $10 million per year and about 500 people on the waiting list.

By contrast, Illinois has no arbitrary cap on program spending; the CCP operates as an entitlement without a waiting list.7 Funds are authorized to meet projected program needs, and supplemental funds can be sought to ensure



that all eligible applicants can be served. The CCP provides services to both Medicaid HCBS waiver enrollees and non-Medicaid enrolled adults. Services for enrollees without Medicaid are funded from general revenues.

Program funding also is relatively secure in Pennsylvania because lottery revenues are earmarked for programs for older adults, including HCBS programs. In a few programs,

Medicaid also has become a source of funding for historically state-funded-only programs.

Washington recently secured a Medicaid waiver for vulnerable family caregivers and older adults who do not receive Medicaid (exhibit 4). This program is an emerging innovation because it combines the federal budget assistance of Medicaid with some of the state flexibilities, expanded eligibility, and speed of enrollment of a state-funded program.

EXHIBIT 4Washington State’s Emerging Innovation: Medicaid Transformation Demonstration to

Tailor Supports for Near Poor Older Adults and Family Caregivers

Effective September 2017, Washington’s Medicaid 1115 waiver allows the state to provide services to support unpaid family caregivers, and to provide a small benefit to near poor individuals who do not have an unpaid family caregiver to help them. Services that can be purchased include personal care, home-delivered meals, adult day services, and other supports designed to assist individuals to live in their own home.

The Medicaid Alternative Care (MAC) program supports unpaid caregivers to avoid or delay the need for more intensive Medicaid-funded services. The caregivers must be caring for an older Medicaid-eligible person who meets nursing home level of care. People who choose these services must decide between receiving them or traditional LTSS services such as those in the Medicaid HCBS waiver or Community First Choice.

This waiver also creates a new eligibility category and benefit package for people ages 55+ who are at risk of future Medicaid-funded LTSS but who do not currently meet Medicaid financial eligibility criteria. The Tailored Supports for Older Adults (TSOA) program offers up to $573 per month in assistance and may include the following benefits: adult day services, family caregiver training, counseling/support groups, home modifications, housekeeping, information, meal delivery, personal emergency response systems, respite care, specialized medical equipment and supplies, and transportation. Individuals who do not have an unpaid caregiver may receive personal care.

People who participate in this demonstration are not subject to Medicaid estate recovery or cost sharing. They also can begin HCBS under a presumptive eligibility determination, which is much quicker than in the traditional Medicaid program because they do not have to wait for the Medicaid eligibility process, which can take up to 45 days.

The cost of this demonstration is roughly $400 a month for each member, compared with roughly $2,000 in the traditional Medicaid personal care program. During the first year, 2,222 clients participated in the demonstration (57 clients in MAC; 616 TSOA family caregivers/clients; and 1,549 TSOA individuals). However, enrollment is increasing by 40–100 clients each month. An independent evaluation on the demonstration’s impact on delivery systems, care, health outcomes, and costs will be conducted; for more information, go to https://www.hca.wa.gov/assets/program/mtd-design-for-eval.pdf.



OUTCOMESFew states have the capacity to measure HCBS program outcomes over time, but administrative data help demonstrate their value. Program administrators and state policy makers have championed these programs.

State-funded HCBS programs help fill a pressing need. State-funded services help support family caregivers and prevent the negative consequences of unmet needs for adults who require assistance to remain in the community. Many of these programs have been in existence for decades, having demonstrated success in meeting the needs of adults and improving quality of life. Program administrators, advocates, families, and policy makers have advocated strongly for these programs and the need to improve the infrastructure for HCBS.

Few states have the capacity to formally evaluate program outcomes (e.g., enrollee and caregiver satisfaction, quality of life, care plan adequacy, reduced transitions to Medicaid, nursing home

8 Oregon Project Independence often has a waiting list. AAAs maintain a list of individuals who are eligible to be served by Oregon Project Independence but are unable to be served because of funding limitations. To assess the value of the program, the unable to serve lists of individuals are evaluated to determine how many of these individuals accessed Medicaid-funded services while waiting to be served by Oregon Project Independence. See Oregon Department of Human Services, “2017–19 Agency Budget Request,” (Salem, OR: Department of Human Services, pages 4–5), http://www.o4ad.org/uploads/5/9/2/2/59228911/dhs_apd_arb_17-19_0916.pdf.

diversion, cost savings to the state), but some insights can be gleaned from administrative data.

Oregon Project Independence is linked to the state’s efforts to improve health outcomes. The program empowers individuals to direct their own services and make choices to enhance their quality of life and live as independently as possible. In addition, the program is credited with reducing the number of older adults who access Medicaid-funded LTSS. In 2009, nearly two-thirds (64 percent) of clients had income below FPL, 33 percent had income between 100 and 200 percent of FPL, and 3 percent had income above 200 percent of FPL. Less than 10 percent of clients transitioned to Medicaid-funded services.8

In New Jersey, program administrators also note that relatively few clients transition to Medicaid. Most clients (roughly 50 percent) who leave the program died; about 25 percent disenrolled owing to spend down and enrolling in the state’s Medicaid managed LTSS program.



Conclusion: Strengthening HCBS Programs

Some states—but not most—have made significant investments outside the Medicaid program to provide services and supports to low-income people who need assistance to remain in home and community settings. These state-funded programs help families understand services and use resources wisely; they also provide modest financial assistance with the cost of an overall care plan. Although program expenditures are relatively low for most adults who receive assistance, care plan services help improve quality of life for adults who require assistance, reduce the adverse consequences of unmet needs, and delay or prevent nursing home residence.

The state-funded programs profiled in this paper provide examples of promising practices in delivering flexible and cost-effective services and supports, blending private and public resources, leveraging other sources of funding, and reinforcing family caregiving. Additional funding, such as that received by some states through Medicaid waivers, can help alleviate the financial burden on state governments and allow states to extend services to people who, today, have income or resources above Medicaid’s eligibility thresholds. With additional funding, these programs could be expanded to improve services, especially for those with the highest level of need and their family caregivers.


PROMISING PRACTICES AND AN EMERGING INNOVATIONA

pp

end

ix.

HC

BS

Pro

gram

s in

Ni

ELIG

IBI

PRO

GR

AM

A

GE,

CLI

NIC

AL

STA

RT

DAT

E,

ELIG

IBIL

ITY/

CA

RE

PRO

GR

AM

A

DM

INIS

TER

ING

N

EED

S, A

SSES

SMEN

T N

AM

EA

GEN

CY

PUR

POSE

PRO

CES

S

ne

Sta

tes:

Pro

gram

Ele

men

tsLI

TYSE

RV

ICES

, BEN

EFIT

D

ESIG

N, C

OST

FI

NA

NC

IAL

CO

NTA

INM

ENT

STR

ATEG

IES

CO

ST P

ER

ELIG

IBIL

ITY

AN

D

(SER

VIC

E LI

MIT

ATIO

NS,

C

ASE

LOA

D,

FUN

DIN

G,

PER

SON

C

OST

SH

AR

ING

CO

ST C

APS

)W

AIT

LIS

TEX

PEN

DIT

UR

ESSE

RV

ED

Con

nect

icut

H

ome

Car

e Pr

ogra

m f

or

Elde

rs (C

HC

PE)

1987

Adm

inis

tere

d by

th

e D

epar

tmen

t of

Soc

ial S

ervi

ces

(DSS

)

DSS

con

trac

ts

with

acc

ess

agen

cies

to

asse

ss th

e ca

re

need

s of

pro

gram

pa

rtic

ipan

ts

and

coor

dina

te

and

man

age

the

serv

ices

pro

vide

d

CH

CPE

hel

ps

elig

ible

clie

nts

live

at h

ome

and

avoi

d nu

rsin

g ho

me

plac

emen

t

Each

app

lican

t’s

need

s re

view

ed

to d

eter

min

e if

they

may

re

mai

n at

hom

e w

ith th

e he

lp

of h

ome

care

se

rvic

es

• A

ge 6

5+

• C

onne

ctic

ut r

esid

ent

• A

t ris

k of

nur

sing

ho

me

plac

emen

t (a

pplic

ant n

eeds

as

sist

ance

with

cri

tical

ne

eds

such

as

bath

ing,

dr

essi

ng, e

atin

g,

taki

ng m

edic

atio

ns,

and

toile

ting;

one

to

two

criti

cal n

eeds

[e

ligib

le fo

r C

ateg

ory

1 se

rvic

es])

• O

r cl

inic

ally

elig

ible

fo

r nu

rsin

g ho

me

care

(v

ery

frai

l, in

nee

d of

sh

ort-

term

or

long

-te

rm n

ursi

ng h

ome

care

; thr

ee c

ritic

al

need

s [e

ligib

le fo

r C

ateg

ory

2 se

rvic

es])

• St

ate-

fund

ed

port

ions

of C

HC

PE

(Cat

egor

ies

1 an

d 2)

hav

e no

inco

me

limit

• A

sset

lim

it =

$3

5,76

6 fo

r an

in

divi

dual

; $47

,688

fo

r a

coup

le

• C

ost s

hari

ng:

Part

icip

ants

in

the

stat

e-fu

nded

pr

ogra

m p

ay 9

% o

f ca

re c

osts

• Pa

rtic

ipan

ts w

ith

inco

me

abov

e 20

0% o

f the

FPL

; (c

urre

ntly

$22

,340

fo

r on

e pe

rson

) m

ust c

ontr

ibut

e ba

sed

on th

eir

appl

ied

inco

me

(Par

ticip

ants

re

sidi

ng in

af

ford

able

hou

sing

un

der

the

stat

e’s

assi

sted

livi

ng

dem

onst

ratio

n pr

ojec

t pay

onl

y th

e ap

plie

d in

com

e ab

ove

200%

of F

PL.)

• C

HC

PE

supp

lem

ents

and

do

es n

ot s

uppl

ant

exis

ting

help

(All

avai

labl

e th

ird-

part

y pa

ymen

ts, s

uch

as

Med

icar

e, m

ust b

e ex

haus

ted.

)

Car

e pl

an li

mits

:

Cat

egor

y 1:

Lim

ited

hom

e ca

re fo

r m

oder

atel

y fr

ail e

lder

s, a

t ris

k of

ho

spita

lizat

ion

or s

hort

-ter

m

nurs

ing

hom

e pl

acem

ent;

care

pl

an li

mit

= 2

5% o

f nur

sing

ho

me

cost

s ($

1,44

5 m

onth

ly)

Cat

egor

y 2:

Inte

rmed

iate

ho

me

care

for

very

frai

l eld

ers

with

som

e as

sets

abo

ve th

e M

edic

aid

limits

; car

e pl

an li

mit

= 5

0% o

f nur

sing

hom

e co

sts

($2,

889

mon

thly

)

• A

dult

day

heal

th s

ervi

ces

• A

dult

fam

ily li

ving

• C

are

man

agem

ent

• C

hore

ser

vice

s

• C

ompa

nion

ser

vice

s

• H

omem

aker

ser

vice

s

• H

ome-

deliv

ered

mea

ls

• H

ome

heal

th s

ervi

ces

• La

undr

y se

rvic

es

• M

enta

l hea

lth c

ouns

elin

g

• R

espi

te c

are

• Pe

rson

al e

mer

genc

y re

spon

se s

yste

m

• Tr

ansp

orta

tion

2,75

0 =

m

onth

ly

aver

age

num

ber

of

clie

nts

in th

e st

ate-

fund

ed

port

ion

of

CH

CPE

Cat

egor

y 1

clos

ed to

new

en

rolle

es

Mon

thly

av

erag

e in

st

ate-

fund

ed

and

wai

ver

port

ions

=

16,3

37

Mon

thly

av

erag

e in

M

edic

aid

wai

ver

port

ion

=

12,2

24

Stat

e an

d fe

dera

l fu

nds

(Med

icai

d an

d So

cial

Se

rvic

es B

lock

G

rant

)

$44,

502,

082

=

stat

e fu

nded

Tota

l $1

89,7

26,3

58

$715

= a

vera

ge

mon

thly

clie

nt

cost

in s

tate

-fu

nded

por

tion

of

CH

CPE



PRO

GR

AM

N

AM

E

PRO

GR

AM

ST

AR

T D

ATE,

A

DM

INIS

TER

ING

A

GEN

CY

PUR

POSE

ELIG

IBIL

ITY

SER

VIC

ES, B

ENEF

IT

DES

IGN

, CO

ST

CO

NTA

INM

ENT

STR

ATEG

IES

(SER

VIC

E LI

MIT

ATIO

NS,

C

OST

CA

PS)

CA

SELO

AD

, W

AIT

LIS

TFU

ND

ING

, EX

PEN

DIT

UR

ES

CO

ST P

ER

PER

SON

SE

RV

ED

AG

E, C

LIN

ICA

L EL

IGIB

ILIT

Y/C

AR

E N

EED

S, A

SSES

SMEN

T PR

OC

ESS

FIN

AN

CIA

L EL

IGIB

ILIT

Y A

ND

C

OST

SH

AR

ING

Illin

ois

Com

mun

ity

Car

e Pr

ogra

m

(CC

P)

1979

(Pub

lic A

ct

81-2

02)

Adm

inis

tere

d by

th

e D

epar

tmen

t on

Agi

ng (D

OA

)

DO

A c

ontr

acts

w

ith C

CU

s fo

r lo

cal

adm

inis

trat

ion

of

CC

P

CC

Us

serv

e as

ce

ntra

l acc

ess

poin

ts fo

r ol

der

adul

ts w

ho h

ave

inte

nsiv

e lo

ng-

term

car

e ne

eds

To p

rovi

de a

co

st-e

ffec

tive

and

acce

ssib

le

syst

em o

f ho

me-

and

co

mm

unity

-ba

sed

serv

ices

th

at p

rovi

des

alte

rnat

ives

to

dela

y or

pre

vent

nu

rsin

g ho

me

plac

emen

t

DO

A h

as

Div

isio

n of

Lo

ng-T

erm

C

are

that

ad

min

iste

rs

CC

P, w

hich

co

mbi

nes

a st

ate-

fund

ed

entit

lem

ent

and

a M

edic

aid

sect

ion

1915

(c)

wai

ver

to

prov

ide

HC

BS

to p

eopl

e ag

es

60 a

nd o

lder

Hav

e an

ass

esse

d ne

ed

for

long

-ter

m c

are

(to

be

at r

isk

for

nurs

ing

faci

lity

plac

emen

t as

mea

sure

d by

the

Det

erm

inat

ion

of

Nee

d [D

ON

] ass

essm

ent)

DO

N d

efine

s th

e fa

ctor

s th

at h

elp

dete

rmin

e a

pers

on’s

func

tiona

l ca

paci

ty a

nd h

is o

r he

r un

met

nee

d fo

r as

sist

ance

in d

ealin

g w

ith

thes

e im

pairm

ents

Indi

vidu

als

elig

ible

for

CC

P se

rvic

es if

they

re

ceiv

e m

inim

um s

core

of

29

poin

ts o

n D

ON

• N

o in

com

e lim

it;

asse

t lim

it:

none

xem

pt a

sset

s of

$17

,500

or

less

; ex

empt

ass

ets

incl

ude

hom

e,

car,

and

pers

onal

fu

rnis

hing

s

• A

lthou

gh n

o in

com

e lim

it, a

n in

com

e le

vel i

s es

tabl

ishe

d to

det

erm

ine

part

icip

ant’s

abi

lity

to c

ontr

ibut

e to

co

st o

f car

e

• C

lient

agr

ees

to

pay

port

ion

of

all i

ncom

e th

at

exce

eds

FPL

to th

e pr

ovid

er a

s co

st

shar

ing

for

the

mon

thly

cos

t of

care

CC

U c

are

coor

dina

tor

asse

sses

nee

ds a

nd

dete

rmin

es e

ligib

ility

for

vario

us p

rogr

ams,

dev

elop

s pl

an o

f car

e, a

nd a

rran

ges

for

serv

ices

Serv

ices

incl

ude

in-h

ome

care

(hom

emak

er, c

hore

), ad

ult d

ay c

are,

em

erge

ncy

hom

e re

spon

se, a

utom

ated

m

edic

atio

n di

spen

ser,

info

rmat

ion

and

refe

rral

, an

d co

mpr

ehen

sive

car

e co

ordi

natio

n

DO

N u

sed

to d

eter

min

e pr

ogra

m e

ligib

ility

and

al

loca

te s

ervi

ce d

olla

rs

acco

rdin

g to

a S

ervi

ce C

ost

Max

imum

sch

edul

e

As o

f Se

ptem

ber

2018

, to

tal a

ging

pa

rtic

ipan

ts

= 1

07,9

08

(30,

733

with

a

Med

icai

d m

anag

ed c

are

orga

niza

tion,

39

,251

on

CC

P an

d on

M

edic

aid,

and

37

,924

on

CC

P an

d no

n-M

edic

aid)

Roug

hly

half

of

the

clie

nts

are

non-

Med

icai

d

No

wai

t lis

t; al

l ap

plic

ants

who

m

eet e

ligib

ility

re

ceiv

e se

rvic

es

Stat

e fu

nds

cove

r no

n-M

edic

aid

enro

llees

in C

CP

$800

mill

ion

tota

l ap

prop

riate

d st

ate

fund

s fo

r FY

201

9, w

hich

in

clud

es a

bout

50

per

cent

for

Med

icai

d. T

he

fund

s us

ed fo

r th

e C

CP

are

gene

ral f

unds

an

d la

ter,

afte

r se

rvic

es a

re p

aid,

re

imbu

rsem

ent

for

Med

icai

d cl

ient

s is

re

ques

ted.

For

FY 2

019,

pr

ojec

tion

of a

n av

erag

e m

onth

ly

cost

of c

are

for

CC

P pa

rtic

ipan

ts

= $

983.

34 (T

his

incl

udes

ser

vice

s an

d ca

se

man

agem

ent.

)



PRO

GR

AM

N

AM

E

PRO

GR

AM

ST

AR

T D

ATE,

A

DM

INIS

TER

ING

A

GEN

CY

PUR

POSE

ELIG

IBIL

ITY

SER

VIC

ES, B

ENEF

IT

DES

IGN

, CO

ST

CO

NTA

INM

ENT

STR

ATEG

IES

(SER

VIC

E LI

MIT

ATIO

NS,

C

OST

CA

PS)

CA

SELO

AD

, W

AIT

LIS

TFU

ND

ING

, EX

PEN

DIT

UR

ES

CO

ST P

ER

PER

SON

SE

RV

ED

AG

E, C

LIN

ICA

L EL

IGIB

ILIT

Y/C

AR

E N

EED

S, A

SSES

SMEN

T PR

OC

ESS

FIN

AN

CIA

L EL

IGIB

ILIT

Y A

ND

C

OST

SH

AR

ING

Mas

sach

uset

ts

Hom

e C

are

Prog

ram

1973

Exec

utiv

e O

ffice

of

Eld

er A

ffai

rs

Loca

lly

adm

inis

tere

d by

26

ASA

Ps

Assi

sts

elde

rs

to s

ecur

e an

d m

aint

ain

max

imum

in

depe

nden

ce

in th

eir

hom

e en

viro

nmen

t

• El

igib

ility

bas

ed

on a

ge, r

esid

ence

, in

com

e, a

nd a

bilit

y to

car

ry o

ut d

aily

ta

sks

such

as

bath

ing,

dre

ssin

g, a

nd

prep

arin

g m

eals

• M

ust b

e a

Mas

sach

uset

ts

resi

dent

• M

ust b

e ag

e 60

or

olde

r, or

you

nger

th

an 6

0 ye

ars

with

a p

hysi

cian

’s

docu

men

ted

diag

nosi

s of

Alz

heim

er’s

dis

ease

, a

rela

ted

diso

rder

, or

othe

r de

men

tia

• M

ust l

ive

at h

ome

or in

the

hom

e of

a

care

give

r (c

anno

t re

side

in a

n ad

ult

fost

er h

ome,

ass

iste

d liv

ing

resi

denc

e, o

r sk

illed

nur

sing

faci

lity)

• M

ust r

equi

re

assi

stan

ce w

ith a

t le

ast o

ne A

DL

and

have

a c

ritic

al u

nmet

ne

ed (a

ny A

DL,

mea

l pr

epar

atio

n, fo

od

shop

ping

, hom

e he

alth

se

rvic

es, m

edic

atio

n m

anag

emen

t, r

espi

te

care

, tra

nspo

rtat

ion

for

med

ical

tr

eatm

ents

)

• A

pplic

ants

ass

esse

d us

ing

a co

mpr

ehen

sive

to

ol a

nd a

ssig

ned

a fu

nctio

nal i

mpa

irm

ent

leve

l/pr

iori

ty

• El

igib

le in

divi

dual

s m

ay h

ave

mon

thly

co

paym

ent f

or

serv

ices

bas

ed o

n in

com

e am

ount

• C

opay

men

ts in

th

e fo

rm o

f a fi

xed

mon

thly

am

ount

or

a p

erce

ntag

e of

a s

ervi

ce

rend

ered

for

whi

ch

the

cons

umer

is

resp

onsi

ble

• In

com

e el

igib

ility

th

resh

olds

adj

uste

d an

nual

ly b

y co

st o

f liv

ing

• In

com

e-re

late

d co

st s

hari

ng

requ

ired

(mon

thly

co

paym

ent o

f $10

to

$14

1 fo

r an

in

divi

dual

in 2

017)

• C

ost s

hari

ng m

ay

be w

aive

d in

cas

e of

har

dshi

p, b

ut

indi

vidu

als

may

be

dis

enro

lled

for

nonp

aym

ent

• Vo

lunt

ary

copa

ymen

t

• A

nnua

l re

dete

rmin

atio

n of

el

igib

ility

• Fi

nanc

ial E

ligib

ility

G

uide

lines

adj

uste

d an

nual

ly b

y a

cost

-of

-livi

ng in

dex

• In

terd

isci

plin

ary

team

of

care

man

ager

s an

d nu

rses

fr

om A

SAPs

con

duct

s an

as

sess

men

t in

the

pers

on’s

ho

me

to d

eter

min

e el

igib

ility

for

the

prog

ram

s

• Fi

nal s

ervi

ces

dete

rmin

ed

on a

cas

e-by

-cas

e ba

sis

and

are

wri

tten

up

in a

car

e m

anag

emen

t pla

n. T

hey

may

incl

ude

any

of th

e fo

llow

ing:

—

Adu

lt da

y he

alth

car

e—

Alz

heim

er’s

/dem

entia

ca

re—

Com

pani

on s

ervi

ces

— C

hore

ser

vice

s—

Food

sho

ppin

g—

Hom

e he

alth

aid

es—

Hom

e he

alth

ser

vice

s—

Hom

emak

er s

ervi

ces,

in

clud

ing

laun

dry

— M

eal d

eliv

ery

— M

eal p

lann

ing

and

prep

arat

ion

— M

edic

atio

n as

sist

ance

— M

inor

hom

e re

pair

and

yard

wor

k—

Nut

ritio

n co

unse

ling

— Pe

rson

al c

are

serv

ices

— Pe

rson

al e

mer

genc

y re

spon

se s

ervi

ces

— R

espi

te c

are

— Sk

illed

nur

sing

car

e—

Tran

spor

tatio

n as

sist

ance

47,0

00 lo

w-

inco

me

olde

r ad

ults

thro

ugh

its H

ome

Car

e Pr

ogra

m,

incl

udin

g th

e Ba

sic

Hom

e C

are

Prog

ram

(w

ith 3

1,50

4 en

rolle

es) a

nd

thre

e re

late

d pr

ogra

ms:

En

hanc

ed

Com

mun

ity

Opt

ions

(9

,843

); Re

spite

O

ver

Inco

me

(5,7

31),

whi

ch b

egan

as

a r

espi

te

prog

ram

in

1985

; and

H

ome

Car

e O

ver

Inco

me

(199

), w

hich

be

gan

in 2

017

NA

N

A



PRO

GR

AM

N

AM

E

PRO

GR

AM

ST

AR

T D

ATE,

A

DM

INIS

TER

ING

A

GEN

CY

PUR

POSE

ELIG

IBIL

ITY

SER

VIC

ES, B

ENEF

IT

DES

IGN

, CO

ST

CO

NTA

INM

ENT

STR

ATEG

IES

(SER

VIC

E LI

MIT

ATIO

NS,

C

OST

CA

PS)

CA

SELO

AD

, W

AIT

LIS

TFU

ND

ING

, EX

PEN

DIT

UR

ES

CO

ST P

ER

PER

SON

SE

RV

ED

AG

E, C

LIN

ICA

L EL

IGIB

ILIT

Y/C

AR

E N

EED

S, A

SSES

SMEN

T PR

OC

ESS

FIN

AN

CIA

L EL

IGIB

ILIT

Y A

ND

C

OST

SH

AR

ING

Mas

sach

uset

ts

Enha

nced

C

omm

unit

y O

ptio

ns

Prog

ram

(E

CO

P)

1993

Exec

utiv

e O

ffice

of

Eld

er A

ffai

rs

Loca

lly

adm

inis

tere

d by

26

ASA

Ps

Enha

nced

C

omm

unity

O

ptio

ns

Prog

ram

de

sign

ed

to a

ddre

ss

the

need

s of

nu

rsin

g ho

me–

elig

ible

eld

ers

who

do

not

qual

ify fo

r M

ass

Hea

lth s

tand

ard

and

who

requ

ire

addi

tiona

l su

ppor

ts

and

serv

ices

to

rem

ain

safe

ly a

nd

inde

pend

ently

at

hom

e

Part

icip

ants

mus

t be

asse

ssed

and

det

erm

ined

to

req

uire

the

leve

l of

car

e pr

ovid

ed in

a

skill

ed n

ursi

ng fa

cilit

y (o

r nu

rsin

g ho

me)

Car

e m

anag

er/

nurs

e te

am fr

om E

lder

Se

rvic

es c

ondu

cts

need

s as

sess

men

t to

dete

rmin

e el

igib

ility

. Thi

s te

am w

ill w

ork

with

the

olde

r ad

ult a

nd h

is o

r he

r fa

mily

mem

bers

to

dete

rmin

e a

plan

of c

are

and

offe

r on

goin

g ca

se

man

agem

ent s

uppo

rt.

Elig

ibili

ty re

quire

men

ts:

• M

eet t

he e

ligib

ility

gu

idel

ines

for

the

stat

e H

ome

Car

e Pr

ogra

m

• M

eet c

linic

al e

ligib

ility

re

quir

emen

ts fo

r nu

rsin

g fa

cilit

y pl

acem

ent

• R

equi

re h

ome

care

se

rvic

es g

reat

er

than

tw

o tim

es th

ose

avai

labl

e th

roug

h th

e ge

nera

l sta

te H

ome

Car

e Pr

ogra

m

Enha

nced

C

omm

unity

Opt

ions

Pr

ogra

m h

as s

ame

finan

cial

elig

ibili

ty

requ

irem

ents

as

Hom

e C

are

Prog

ram

As o

f 201

7, fo

r fin

anci

al a

ssis

tanc

e fo

r ho

me

care

se

rvic

es, s

ingl

e ad

ult

mus

t hav

e an

nual

in

com

e of

less

than

$2

6,56

1; fo

r a

coup

le,

less

than

$37

,581

Sam

e se

rvic

es a

s ba

sic

Hom

e C

are

Prog

ram

(see

abo

ve)

Con

sum

ers

on E

CO

P re

ceiv

e ho

me

visi

ts m

ore

freq

uent

ly

and

have

hig

her

mon

thly

do

llar

amou

nt a

vaila

ble

to

them

to d

esig

n a

serv

ice

plan

to

mee

t the

ir sp

ecifi

c ne

eds

9,84

3N

AN

A

Neb

rask

a C

are

Man

agem

ent

2008

To a

ssis

t old

er

indi

vidu

als

in

coor

dina

ting

in-h

ome

and

com

mun

ity-

base

d ca

re,

prov

ided

by

the

AA

As

Indi

vidu

als

ages

60+

All

indi

vidu

als

ages

60

+ e

ligib

le, b

ut th

ere

is a

slid

ing

fee

scal

e ba

sed

on in

com

e

No

cost

sha

ring

for

unde

r 14

9% o

f FPL

; 10

0% c

ost s

harin

g fo

r 30

0% o

f FPL

Info

rmat

ion

and

refe

rral

and

ca

se m

anag

emen

t4,

151

in 2

017

49,4

46 h

ours

in

201

7

$2.3

mill

ion

in

2018

NA



PRO

GR

AM

N

AM

E

PRO

GR

AM

ST

AR

T D

ATE,

A

DM

INIS

TER

ING

A

GEN

CY

PUR

POSE

ELIG

IBIL

ITY

SER

VIC

ES, B

ENEF

IT

DES

IGN

, CO

ST

CO

NTA

INM

ENT

STR

ATEG

IES

(SER

VIC

E LI

MIT

ATIO

NS,

C

OST

CA

PS)

CA

SELO

AD

, W

AIT

LIS

TFU

ND

ING

, EX

PEN

DIT

UR

ES

CO

ST P

ER

PER

SON

SE

RV

ED

AG

E, C

LIN

ICA

L EL

IGIB

ILIT

Y/C

AR

E N

EED

S, A

SSES

SMEN

T PR

OC

ESS

FIN

AN

CIA

L EL

IGIB

ILIT

Y A

ND

C

OST

SH

AR

ING

Neb

rask

a Li

fesp

an

Resp

ite

2002

To g

ive

care

give

rs a

br

eak

from

th

e de

man

ds

of p

rovi

ding

on

goin

g ca

re fo

r an

in

divi

dual

with

sp

ecia

l nee

ds

rega

rdle

ss o

f th

e in

divi

dual

’s di

sabi

lity

and/

or c

hron

ic

illne

ss

diag

nosi

s,

spec

ial n

eeds

, or

fam

ily

circ

umst

ance

s

To c

oord

inat

e co

mm

unity

re

spite

ser

vice

s an

d to

pro

vide

fu

ndin

g fo

r ca

regi

vers

to

pur

chas

e re

spite

ser

vice

s

Indi

vidu

als

of a

ny

age

with

a s

peci

al

need

who

live

with

an

unpa

id c

areg

iver

in a

no

nins

titut

iona

l set

ting

and

mee

t fina

ncia

l cr

iteria

. Spe

cial

nee

ds

incl

ude,

but

are

not

lim

ited

to, d

evel

opm

enta

l di

sabi

litie

s; p

hysi

cal

disa

bilit

ies;

chr

onic

ill

ness

; phy

sica

l, m

enta

l, or

em

otio

nal

cond

ition

s; s

peci

al h

ealth

ca

re n

eeds

; cog

nitiv

e im

pairm

ents

that

req

uire

on

goin

g su

perv

isio

n; o

r si

tuat

ions

in w

hich

ther

e is

a h

igh

risk

of a

buse

or

negl

ect f

or th

e in

divi

dual

w

ith s

peci

al n

eeds

.

For

indi

vidu

als

who

ar

e in

elig

ible

for

othe

r go

vern

men

t-fu

nded

re

spite

ser

vice

s

Clie

nt’s

inco

me

min

us

allo

wab

le d

isre

gard

s m

ust b

e at

or

belo

w

312%

of F

PL to

qua

lify

$125

per

mon

th a

nd u

p to

$1,

000

per

year

for

exce

ptio

nal n

eeds

Fam

ilies

can

ban

k re

spite

su

bsid

ies

for

mon

ths

and

then

us

e th

em fo

r ca

mps

or

adul

t da

y he

alth

340

on a

ny

give

n da

y in

20

17 O

R 94

9 to

tal f

or 2

016

$810

,000

for

dire

ct s

ervi

ces

+ $

404,

643

for

infr

astr

uctu

re in

20

17

NA



PRO

GR

AM

N

AM

E

PRO

GR

AM

ST

AR

T D

ATE,

A

DM

INIS

TER

ING

A

GEN

CY

PUR

POSE

ELIG

IBIL

ITY

SER

VIC

ES, B

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IT

DES

IGN

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ST

CO

NTA

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ENT

STR

ATEG

IES

(SER

VIC

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MIT

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AD

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AIT

LIS

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ND

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DIT

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RV

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AG

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SSES

SMEN

T PR

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FIN

AN

CIA

L EL

IGIB

ILIT

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ND

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OST

SH

AR

ING

Neb

rask

a So

cial

Ser

vice

s fo

r A

ged

and

Dis

able

d (S

SAD

) Adu

lts

prog

ram

1973

Adm

inis

tere

d by

Neb

rask

a D

epar

tmen

t of

Hea

lth a

nd

Hum

an S

ervi

ces

To o

ffer

tw

o ty

pes

of s

uppo

rt

serv

ices

to

Neb

rask

a re

side

nts:

su

ppor

t ta

rget

ed a

t the

in

divi

dual

in

need

of c

are

and

supp

ort

targ

eted

at h

is

or h

er p

rimar

y ca

regi

ver.

SSA

D’s

goal

is

to h

elp

frai

l sen

iors

co

ntin

ue

to li

ve a

s in

depe

nden

tly

as p

ossi

ble,

an

d as

suc

h,

serv

ices

are

pr

ovid

ed to

be

nefic

iarie

s in

thei

r ho

mes

an

d in

the

com

mun

ity, b

ut

not t

o pe

ople

re

sidi

ng in

sk

illed

nur

sing

re

side

nces

. Th

e ex

cept

ion

to th

is is

whe

n nu

rsin

g ho

me

resi

denc

y is

te

mpo

rary

and

th

e in

divi

dual

w

ill b

e re

turn

ing

to li

ve in

his

or

her

hom

e at

so

me

poin

t in

the

near

futu

re.

Targ

eted

to in

divi

dual

s w

ho n

eed

low

er le

vels

of

care

at h

ome

than

thos

e in

the

Med

icai

d Pe

rson

al

Assi

stan

ce S

ervi

ces

prog

ram

To q

ualif

y fo

r se

rvic

es,

one

mus

t be

the

follo

win

g:

• A

lega

l res

iden

t of t

he

stat

e of

Neb

rask

a

• 60

yea

rs o

f age

, or

blin

d an

d be

twee

n th

e ag

es o

f 19

and

59, o

r de

term

ined

di

sabl

ed b

y a

med

ical

pr

ofes

sion

al

• Ph

ysic

ally

or

men

tally

im

pair

ed s

uch

that

as

sist

ance

is r

equi

red

for

AD

Ls

• Li

ving

at h

ome

or

tem

pora

rily

res

idin

g in

reh

abili

tatio

n an

d in

tend

ing

to r

etur

n ho

me

Serv

ice

need

s as

sess

men

t can

be

cond

ucte

d ov

er p

hone

Inco

me

guid

elin

es

chan

ge e

ach

year

w

ith c

ost-

of-li

ving

ad

just

men

ts. I

n 20

18,

the

appr

oxim

ate

limit

for

an in

divi

dual

was

$1

,149

per

mon

th a

nd

for

a m

arrie

d co

uple

w

as $

1,28

8 pe

r m

onth

. Or,

in a

nnua

l te

rms,

und

er $

13,7

76

for

an in

divi

dual

and

un

der

$15,

459

for

a m

arrie

d co

uple

/tw

o-pe

rson

hou

seho

ld.

How

ever

, ind

ivid

uals

w

ith in

com

es o

ver

thes

e th

resh

olds

may

st

ill q

ualif

y, a

s th

ere

are

man

y ex

cept

ions

to

wha

t is

cons

ider

ed

coun

tabl

e in

com

e.

Cur

rent

ly, t

here

are

no

asse

t lim

its.

No

cost

sha

ring

Som

e re

cipi

ents

ar

e on

Med

icai

d bu

t do

NO

T qu

alify

for

pers

onal

ass

ista

nce

serv

ices

bec

ause

of

a lo

wer

leve

l of

func

tiona

l nee

d

Gre

at fl

exib

ility

re

gard

ing

reso

urce

s an

d ex

cept

ions

• A

dult

day

care

• C

hore

ser

vice

s

• Fo

od p

repa

ratio

n

• G

roce

ry s

hopp

ing

• G

roup

mea

ls (i

n se

nior

ce

nter

s)

• H

omem

aker

ser

vice

s

• H

ouse

clea

ning

• La

undr

y

• M

eal d

eliv

ery

• Pe

rson

al c

are

(lim

ited)

• Tr

ansp

orta

tion

assi

stan

ce

Serv

ice

limits

:•

Cho

res

limite

d to

15

hour

s pe

r w

eek

• Tr

ansp

orta

tion

for s

hopp

ing

is o

ne tr

ip a

wee

k

• Tr

ansp

orta

tion

for

lega

l and

fin

anci

al s

ervi

ces

limite

d to

tw

ice

a m

onth

• O

ne m

eal a

day

lim

it

• A

dult

day

limite

d to

thre

e da

ys a

wee

k bu

t allo

ws

for

exce

ptio

nsU

npai

d ca

regi

vers

(but

not

sp

ouse

s or

som

eone

lega

lly

resp

onsi

ble)

can

get

pai

d,

but t

hey

need

to c

ompl

ete

trai

ning

and

bac

kgro

und

chec

k

Cur

rent

ly

4,04

9 in

divi

dual

s re

ceiv

e SS

AD

se

rvic

es.

No

wai

t lis

t

$8,2

43,5

67

($94

1,42

0 fr

om fe

dera

l So

cial

Ser

vice

s Bl

ock

Gra

nt;

$7,3

02,1

47 fr

om

stat

e ge

nera

l fu

nds)

Aver

age

cost

a

year

per

per

son:

Con

greg

ate

mea

ls: $

651;

ad

ult d

ay

serv

ices

: $2,

735;

ho

me-

base

d se

rvic

es

chor

e: $

1,68

3;

tran

spor

tatio

n:

$1,5

29



PRO

GR

AM

N

AM

E

PRO

GR

AM

ST

AR

T D

ATE,

A

DM

INIS

TER

ING

A

GEN

CY

PUR

POSE

ELIG

IBIL

ITY

SER

VIC

ES, B

ENEF

IT

DES

IGN

, CO

ST

CO

NTA

INM

ENT

STR

ATEG

IES

(SER

VIC

E LI

MIT

ATIO

NS,

C

OST

CA

PS)

CA

SELO

AD

, W

AIT

LIS

TFU

ND

ING

, EX

PEN

DIT

UR

ES

CO

ST P

ER

PER

SON

SE

RV

ED

AG

E, C

LIN

ICA

L EL

IGIB

ILIT

Y/C

AR

E N

EED

S, A

SSES

SMEN

T PR

OC

ESS

FIN

AN

CIA

L EL

IGIB

ILIT

Y A

ND

C

OST

SH

AR

ING

New

Jer

sey

Jers

ey

Ass

ista

nce

for

Com

mun

ity

Car

egiv

ing

(JA

CC

)

Esta

blis

hed

in

2000

Ove

rsee

n by

N

ew Je

rsey

D

epar

tmen

t of

Hum

an S

ervi

ces,

D

ivis

ion

of

Agi

ng S

ervi

ces;

ad

min

iste

red

by

loca

l AA

As (A

ging

an

d D

isab

ility

Re

sour

ce

Con

nect

ion)

Prov

ides

a

broa

d ar

ray

of in

-hom

e se

rvic

es to

en

able

an

indi

vidu

al w

ho

is a

t ris

k of

pl

acem

ent

in a

nur

sing

fa

cilit

y an

d w

ho

mee

ts in

com

e an

d re

sour

ce

requ

irem

ents

to

rem

ain

in h

is o

r he

r co

mm

unity

ho

me

• A

ge 6

0 ye

ars

or o

lder

• R

esid

es in

a h

ome

that

th

ey o

wn

or r

ent,

or

lives

in a

n un

licen

sed

hom

e of

a r

elat

ive

or

frie

nd

• H

as n

o al

tern

ate

mea

ns a

vaila

ble

to s

ecur

e ne

eded

se

rvic

es a

nd/o

r su

ppor

ts

• H

as b

een

dete

rmin

ed

to b

e cl

inic

ally

elig

ible

fo

r nu

rsin

g fa

cilit

y le

vel o

f car

e (a

s de

term

ined

by

Stat

e re

gula

tion

N.J

.A.C

. 8:

85-2

.1)

• Is

a U

S ci

tizen

or

a qu

alifi

ed a

lien

• Is

not

fina

ncia

lly

elig

ible

for

Med

icai

d m

anag

ed

LTSS

or

othe

r fa

mily

ca

re p

rogr

am

• A

sset

lim

it:

Cou

ntab

le

reso

urce

s m

ust b

e le

ss th

an $

40,0

00

for

a si

ngle

per

son

or $

60,0

00 fo

r a

coup

le (e

xclu

des

valu

e of

a h

ome

and

pers

onal

eff

ects

)

• C

ost s

hari

ng:

Enro

llees

with

in

com

e ab

ove

FPL

are

asse

ssed

in

com

e-re

late

d co

paym

ents

of $

15

to $

120

per

mon

th

• B

ased

on

the

resu

lts

of

a cl

inic

al a

sses

smen

t,

plan

of c

are

deve

lope

d co

llabo

rati

vely

by

part

icip

ant a

nd h

is o

r he

r ca

re m

anag

er

• A

ll JA

CC

par

ticip

ants

re

ceiv

e ca

re m

anag

emen

t se

rvic

es

• O

ther

pla

n of

car

e se

rvic

es

may

incl

ude

resp

ite c

are,

ho

mem

aker

ser

vice

s,

envi

ronm

enta

l acc

essi

bilit

y ad

apta

tions

, per

sona

l em

erge

ncy

resp

onse

sy

stem

s, h

ome-

deliv

ered

m

eal s

ervi

ce, c

areg

iver

/re

cipi

ent t

rain

ing,

soc

ial

adul

t day

car

e, a

dult

day

heal

th s

ervi

ces,

spe

cial

m

edic

al e

quip

men

t and

su

pplie

s, tr

ansp

orta

tion,

ch

ore

serv

ices

, att

enda

nt

care

, or

hom

e-ba

sed

supp

orti

ve c

are

• Pa

rtic

ipan

ts m

ay o

pt

for

self-

dire

ctio

n or

Pa

rtic

ipan

t-Em

ploy

ed

Prov

ider

s op

tion.

The

y m

ust h

ave

the

capa

city

and

de

sire

to s

elf-

dire

ct.

• C

ost c

ap o

n se

rvic

es:

Ove

rall

cost

cap

of $

600

per

mon

th, p

lus

cost

cap

s fo

r in

divi

dual

ser

vice

s

Mon

thly

ca

selo

ad:

Abo

ut 1

,300

–1,

500

Stat

e Fi

scal

Ye

ar (S

FY)

2017

tota

l en

rollm

ent:

2,

153

Wai

t lis

t: A

bout

50

0

Ann

ual

appr

opria

tion:

$1

0,00

0,00

0

Cap

ped

at

$7,2

00 p

er y

ear;

$6

00 p

er m

onth



PRO

GR

AM

N

AM

E

PRO

GR

AM

ST

AR

T D

ATE,

A

DM

INIS

TER

ING

A

GEN

CY

PUR

POSE

ELIG

IBIL

ITY

SER

VIC

ES, B

ENEF

IT

DES

IGN

, CO

ST

CO

NTA

INM

ENT

STR

ATEG

IES

(SER

VIC

E LI

MIT

ATIO

NS,

C

OST

CA

PS)

CA

SELO

AD

, W

AIT

LIS

TFU

ND

ING

, EX

PEN

DIT

UR

ES

CO

ST P

ER

PER

SON

SE

RV

ED

AG

E, C

LIN

ICA

L EL

IGIB

ILIT

Y/C

AR

E N

EED

S, A

SSES

SMEN

T PR

OC

ESS

FIN

AN

CIA

L EL

IGIB

ILIT

Y A

ND

C

OST

SH

AR

ING

Nor

th D

akot

a Se

rvic

e Pa

ymen

t fo

r th

e El

derl

y an

d D

isab

led

(SPE

D)

1983

Dep

artm

ent o

f H

uman

Ser

vice

s,

Agi

ng S

ervi

ces

Div

isio

n

Adm

inis

tere

d by

C

ount

y So

cial

Se

rvic

e A

genc

ies

at th

e lo

cal l

evel

Prov

ides

se

rvic

es fo

r pe

ople

who

ar

e ol

der

or

phys

ical

ly

disa

bled

and

w

ho h

ave

diffi

culty

co

mpl

etin

g ta

sks

that

en

able

th

em to

live

in

depe

nden

tly

at h

ome

Prov

ides

an

d pa

ys

for

a va

riety

of

ser

vice

s to

sus

tain

in

divi

dual

s in

thei

r ho

mes

and

co

mm

uniti

es,

espe

cial

ly r

ural

co

mm

uniti

es

• O

lder

adu

lts

and

peop

le w

ith p

hysi

cal

disa

bilit

ies

• B

ased

on

an

asse

ssm

ent:

impa

ired

in

four

AD

Ls o

r in

at

leas

t five

IAD

Ls,

tota

ling

eigh

t or

mor

e po

ints

, or

if liv

ing

alon

e to

talin

g at

leas

t si

x po

ints

• Im

pair

men

ts m

ust

have

last

ed o

r ar

e ex

pect

ed to

last

thre

e m

onth

s or

mor

e

• Is

not

elig

ible

for

a M

edic

aid

wai

ver

• N

eed

for

serv

ice

is

not d

ue to

men

tal

illne

ss o

r in

telle

ctua

l di

sabi

lity

• Pe

rson

is c

apab

le

of d

irec

ting

own

care

or

has

a le

gally

re

spon

sibl

e pa

rty

• Pe

rson

has

nee

ds

with

in th

e sc

ope

of

cove

red

serv

ices

, or

if u

nder

age

18

is

scre

ened

for

nurs

ing

faci

lity

leve

l of c

are

• In

abili

ty to

pay

for

serv

ices

; liq

uid

asse

ts le

ss th

an

$50,

000

• Tw

o co

st-s

hari

ng,

slid

ing-

fee

sche

dule

s: o

ne fo

r pe

ople

with

less

th

an $

25,0

00, a

nd

one

for

peop

le w

ith

mor

e th

an $

25,0

00

but l

ess

than

$5

0,00

0 in

ass

ets

• M

ay n

ot b

e el

igib

le

for

a M

edic

aid

wai

ver

• A

dult

day

care

• A

dult

fost

er c

are

• C

ase

man

agem

ent

• C

hore

ser

vice

s

• Em

erge

ncy

resp

onse

sy

stem

• En

viro

nmen

tal

mod

ifica

tions

• Ex

tend

ed p

erso

n ca

re/

nurs

e ed

ucat

ion

(edu

catio

n gi

ven

by a

nur

se to

an

enro

lled

qual

ified

ser

vice

pr

ovid

er w

ho p

rovi

des

med

ical

car

e sp

ecifi

c to

a

clie

nt’s

nee

ds)

• Fa

mily

hom

e ca

re

(rei

mbu

rses

a fa

mily

ca

regi

ver

who

mee

ts th

e re

latio

nshi

p re

quir

emen

ts

defin

ed b

y st

ate

law

and

re

side

s in

a c

lient

’s h

ome

24 h

ours

per

day

)

• H

omem

aker

• H

ome-

deliv

ered

mea

ls

• N

onm

edic

al tr

ansp

orta

tion

• Pe

rson

al c

are

serv

ices

• R

espi

te c

are

SFY

2017

, av

erag

e m

onth

ly

clie

nts:

1,0

25

Stat

e ge

nera

l fu

nds

SFY

2017

: A

nnua

l ap

prop

riatio

n:

$7,7

66,9

14

Ann

ual

expe

nditu

res:

$6

,079

,199

SFY

2017

, av

erag

e m

onth

ly

cost

per

clie

nt:

$494



PRO

GR

AM

N

AM

E

PRO

GR

AM

ST

AR

T D

ATE,

A

DM

INIS

TER

ING

A

GEN

CY

PUR

POSE

ELIG

IBIL

ITY

SER

VIC

ES, B

ENEF

IT

DES

IGN

, CO

ST

CO

NTA

INM

ENT

STR

ATEG

IES

(SER

VIC

E LI

MIT

ATIO

NS,

C

OST

CA

PS)

CA

SELO

AD

, W

AIT

LIS

TFU

ND

ING

, EX

PEN

DIT

UR

ES

CO

ST P

ER

PER

SON

SE

RV

ED

AG

E, C

LIN

ICA

L EL

IGIB

ILIT

Y/C

AR

E N

EED

S, A

SSES

SMEN

T PR

OC

ESS

FIN

AN

CIA

L EL

IGIB

ILIT

Y A

ND

C

OST

SH

AR

ING

Nor

th D

akot

a Ex

pand

ed

Serv

ice

Paym

ent

for

the

Elde

rly

and

Dis

able

d (E

xpan

ded-

SPED

or

Ex-

SPED

)

1994

Hum

an S

ervi

ces,

A

ging

Ser

vice

s D

ivis

ion

Adm

inis

tere

d by

C

ount

y So

cial

Se

rvic

e A

genc

ies

at th

e lo

cal l

evel

Pays

for

in-

hom

e an

d co

mm

unity

-ba

sed

serv

ices

fo

r pe

ople

w

ho w

ould

ot

herw

ise

rece

ive

care

in

a lic

ense

d ba

sic

care

faci

lity

Targ

eted

to lo

w-

inco

me

olde

r ad

ults

who

m

ay r

equi

re

som

e A

DL

assi

stan

ce b

ut

who

se p

rimar

y ne

ed is

for

help

w

ith IA

DLs

or

supe

rvis

ion

at h

ome

or

in a

mor

e st

ruct

ured

en

viro

nmen

t (e

.g.,

adul

t fo

ster

car

e)

• O

lder

adu

lts

(age

s 60

+) o

r ad

ults

age

s 19

–59

with

dis

abili

ties

• In

divi

dual

is n

ot

seve

rely

impa

ired

in

the

AD

Ls o

f toi

letin

g,

tran

sfer

ring

, eat

ing

• Im

pair

ed in

thre

e or

four

IAD

Ls:

mea

l pre

para

tion,

ho

usew

ork,

laun

dry,

or

taki

ng m

edic

atio

ns

• H

as h

ealth

, wel

fare

, or

saf

ety

need

s,

incl

udin

g su

perv

isio

n or

str

uctu

red

envi

ronm

ent,

ot

herw

ise

requ

irin

g ca

re in

a b

asic

car

e fa

cilit

y, a

nd h

as n

eeds

w

ithin

the

scop

e of

co

vere

d se

rvic

es

• Lo

w in

com

e: M

ust

be e

nrol

led

in o

r fin

anci

ally

elig

ible

fo

r M

edic

aid

or

Supp

lem

enta

l Se

curi

ty In

com

e

• A

dult

day

care

• A

dult

fost

er c

are

• C

ase

man

agem

ent

• C

hore

ser

vice

s

• Em

erge

ncy

resp

onse

sy

stem

• En

viro

nmen

tal m

odifi

catio

n

• Ex

tend

ed p

erso

nal c

are/

nurs

e ed

ucat

ion

• Fa

mily

hom

e ca

re

• H

omem

aker

• H

ome-

deliv

ered

mea

ls

• N

onm

edic

al tr

ansp

orta

tion

• Pe

rson

al c

are

serv

ices

• R

espi

te c

are

Aver

age

mon

thly

cl

ient

s: 1

40

(SFY

201

7)

Stat

e ge

nera

l fu

nds:

SFY

201

7

Tota

l ap

prop

riatio

n:

$798

,984

Tota

l ex

pend

iture

s:

$686

,514

Aver

age

mon

thly

co

st p

er c

lient

: $4

08 (S

FY 2

017)



PRO

GR

AM

N

AM

E

PRO

GR

AM

ST

AR

T D

ATE,

A

DM

INIS

TER

ING

A

GEN

CY

PUR

POSE

ELIG

IBIL

ITY

SER

VIC

ES, B

ENEF

IT

DES

IGN

, CO

ST

CO

NTA

INM

ENT

STR

ATEG

IES

(SER

VIC

E LI

MIT

ATIO

NS,

C

OST

CA

PS)

CA

SELO

AD

, W

AIT

LIS

TFU

ND

ING

, EX

PEN

DIT

UR

ES

CO

ST P

ER

PER

SON

SE

RV

ED

AG

E, C

LIN

ICA

L EL

IGIB

ILIT

Y/C

AR

E N

EED

S, A

SSES

SMEN

T PR

OC

ESS

FIN

AN

CIA

L EL

IGIB

ILIT

Y A

ND

C

OST

SH

AR

ING

Nor

th D

akot

a D

emen

tia

Car

e Se

rvic

es (D

CS)

Pr

ogra

m

2010

Hou

se B

ill 1

043

(pas

sed

in

2009

) dire

cted

D

epar

tmen

t of

Hum

an S

ervi

ces

to c

ontr

act w

ith

priv

ate

prov

ider

to

dev

elop

and

im

plem

ent

stat

ewid

e D

CS

prog

ram

DC

S pr

ogra

m

adm

inis

tere

d by

Alz

heim

er’s

Asso

ciat

ion

of

Min

neso

ta-N

orth

D

akot

a

Prov

ides

car

e,

cons

ulta

tion,

an

d tr

aini

ng

to c

areg

iver

s to

add

ress

in

divi

dual

ne

eds

that

ar

ise

durin

g va

rious

sta

ges

of d

emen

tia

One

-on-

one

assi

stan

ce

enab

les

indi

vidu

als

and

thei

r ca

regi

vers

to

bett

er m

anag

e ca

re a

nd m

ake

mor

e in

form

ed

deci

sion

s ab

out

serv

ices

and

tr

eatm

ent

Elig

ibili

ty n

ot b

ased

on

age,

dia

gnos

is, o

r in

com

e

Indi

vidu

als

with

dem

entia

an

d th

eir

care

give

rs

elig

ible

to r

ecei

ve c

are

cons

ulta

tion,

edu

catio

n an

d tr

aini

ng, a

nd r

efer

ral

serv

ices

Any

one

elig

ible

to

part

icip

ate

in e

duca

tiona

l se

ssio

ns o

n de

men

tia

• N

o in

com

e el

igib

ility

re

stri

ctio

ns

• N

o co

st to

in

divi

dual

s fo

r pr

ogra

m s

ervi

ces

• C

are

cons

ulta

tion

incl

udin

g as

sess

ing

need

s; id

enti

fyin

g is

sues

, co

ncer

ns, a

nd r

esou

rces

; de

velo

ping

car

e pl

ans;

m

akin

g re

ferr

als;

and

pr

ovid

ing

educ

atio

n an

d fo

llow

-up

• Tr

aini

ng fo

r ca

regi

vers

to

man

age

care

nee

ds fo

r in

divi

dual

s w

ith d

emen

tia

• Fa

cilit

ate

with

ref

erra

ls

to a

ppro

pria

te c

are

and

supp

ort s

ervi

ces

• In

form

atio

n an

d tr

aini

ng to

m

edic

al p

rofe

ssio

ns, l

aw

enfo

rcem

ent,

car

egiv

ers,

an

d th

e pu

blic

reg

ardi

ng

dem

entia

sym

ptom

s,

bene

fits

of e

arly

det

ectio

n an

d tr

eatm

ent,

and

se

rvic

es a

vaila

ble

for

indi

vidu

als

with

dem

entia

an

d th

eir

care

give

rs

July

1, 2

015–

June

30,

201

7

Indi

vidu

als

with

dem

entia

se

rved

: 861

Car

egiv

ers

serv

ed: 1

,838

Car

e co

nsul

tatio

ns:

2,35

8

Stat

e ge

nera

l fu

nds

SFY

2015

ex

pend

iture

s:

$500

,410

SFY

2016

ex

pend

iture

s:

$478

,039

NA



PRO

GR

AM

N

AM

E

PRO

GR

AM

ST

AR

T D

ATE,

A

DM

INIS

TER

ING

A

GEN

CY

PUR

POSE

ELIG

IBIL

ITY

SER

VIC

ES, B

ENEF

IT

DES

IGN

, CO

ST

CO

NTA

INM

ENT

STR

ATEG

IES

(SER

VIC

E LI

MIT

ATIO

NS,

C

OST

CA

PS)

CA

SELO

AD

, W

AIT

LIS

TFU

ND

ING

, EX

PEN

DIT

UR

ES

CO

ST P

ER

PER

SON

SE

RV

ED

AG

E, C

LIN

ICA

L EL

IGIB

ILIT

Y/C

AR

E N

EED

S, A

SSES

SMEN

T PR

OC

ESS

FIN

AN

CIA

L EL

IGIB

ILIT

Y A

ND

C

OST

SH

AR

ING

Ore

gon

Proj

ect

Inde

pend

ence

(O

PI)

1975

(tra

ditio

nal

prog

ram

)

2005

(dis

abili

ty

pilo

t)

Dep

artm

ent o

f H

uman

Ser

vice

s,

Agi

ng a

nd P

eopl

e w

ith D

isab

ilitie

s D

ivis

ion

Prov

ides

in

divi

dual

s ov

er

the

age

of 6

0,

rega

rdle

ss o

f in

com

e, w

ith in

-ho

me

serv

ices

to

hel

p th

em

stay

in th

eir

own

hom

es, t

o pr

omot

e se

lf-de

term

inat

ion

and

agin

g in

pl

ace

Opt

imiz

es

elig

ible

in

divi

dual

s’

pers

onal

and

co

mm

unity

su

ppor

ts to

re

duce

the

risk

of o

ut-o

f-hom

e pl

acem

ent a

nd

prev

ent o

r de

lay

spen

d do

wn

to

mor

e ex

pens

ive

Med

icai

d-fu

nded

long

-te

rm c

area

Trad

ition

al p

rogr

am:

• O

lder

adu

lts

(age

s 60

+)

• Pe

ople

dia

gnos

ed w

ith

Alz

heim

er’s

dis

ease

or

a re

late

d di

sord

erD

isab

ility

pilo

t:•

Peop

le w

ith p

hysi

cal

disa

bilit

ies

ages

19–

59

(pilo

t, n

ot s

tate

wid

e)

• M

ust n

eed

in-h

ome

serv

ices

(i.e

., ne

ed

assi

stan

ce w

ith A

DLs

, IA

DLs

)

• N

eed

asse

ssed

us

ing

(a) t

he C

lient

A

sses

smen

t and

Pl

anni

ng S

yste

m a

nd

(b) a

ris

k as

sess

men

t to

ol th

at a

sses

ses

the

risk

of o

ut-o

f-ho

me

plac

emen

t

• A

pplic

ant a

ssig

ned

a Se

rvic

e Pr

iori

ty L

evel

th

at v

arie

s fr

om 1

(h

ighe

st n

eed)

to 1

8 (lo

wes

t)

• M

ay n

ot b

e en

rolle

d in

Med

icai

d

• El

igib

ility

not

lim

ited

base

d on

in

com

e or

ass

ets

• In

com

e-re

late

d fe

es a

pply

.b

• Se

rvic

es p

rovi

ded

at n

o co

st to

fa

mili

es w

ith n

et

inco

mes

at o

r bel

ow

150%

of F

PL

• Pe

ople

with

inco

me

betw

een

150%

and

40

0% o

f FPL

pay

sl

idin

g sc

ale

fee

(of 5

% to

90%

of

serv

ice

cost

s)

• Fo

r pe

ople

with

in

com

e ab

ove

150%

of F

PL, f

ees

appl

y to

all

serv

ices

ex

cept

ser

vice

co

ordi

natio

n

• Pe

ople

with

net

in

com

e ab

ove

400%

of

FPL

pay

full

cost

of

ser

vice

s

• Tr

aditi

onal

pro

gram

se

rvic

es d

eliv

ered

st

atew

ide

(36

coun

ties)

th

roug

h th

e ne

twor

k of

17

des

igna

ted

AA

As

• O

PI c

ompl

emen

ts s

ervi

ces

prov

ided

und

er O

lder

A

mer

ican

s A

ct

• D

isab

ility

pilo

t lim

ited

to

12 c

ount

ies

(7 A

AA

s)

• O

PI p

rovi

des

esse

ntia

l se

rvic

es, s

uch

as

pers

onal

car

e, h

ome

care

an

d ch

ore

assi

stan

ce,

adul

t day

car

e, s

ervi

ce

coor

dina

tion,

reg

iste

red

nurs

ing

(tea

chin

g/de

lega

tion

of n

ursi

ng t

asks

to

car

egiv

ers)

, and

hom

e-de

liver

ed m

eals

• N

o co

st o

r ho

ur c

aps

• O

ther

aut

hori

zed

serv

ices

fo

r whi

ch O

PI fu

nds

may

be

expe

nded

are

aut

hori

zed

on

a ca

se-b

y-ca

se b

asis

by

the

dire

ctor

of t

he d

epar

tmen

t.

Oth

er a

utho

rize

d se

rvic

es

may

incl

ude

(a) s

ervi

ces

to s

uppo

rt c

omm

unit

y ca

regi

vers

and

str

engt

hen

the

natu

ral s

uppo

rt s

yste

m

of in

divi

dual

s, (b

) evi

denc

e-ba

sed

heal

th p

rom

otio

n se

rvic

es, (

c) o

ptio

ns

coun

selin

g, o

r (d)

ass

iste

d tr

ansp

orta

tion

optio

ns th

at

allo

w in

divi

dual

s to

live

at

hom

e an

d ac

cess

the

full

rang

e of

com

mun

ity

reso

urce

s.

As o

f Jan

uary

25

, 201

7:

1,80

6 in

the

trad

ition

al

prog

ram

; th

e pi

lot

prog

ram

is

serv

ing

293

adul

ts w

ith

disa

bilit

iesc

Wai

t lis

t: Y

es,

in s

ome

area

s

Stat

e ge

nera

l fu

nd fi

nanc

ing.

So

me

coun

ties

add

loca

l fun

ds,

whi

ch g

ives

the

stat

e an

d A

AAs

fle

xibi

lity

in

how

to u

se th

e fu

nds

to m

eet

loca

l nee

ds. O

PI

fund

ing

fluct

uate

s de

pend

ing

on

stat

e ge

nera

l fun

d av

aila

bilit

y:

$26.

6 m

illio

n fo

r 20

15–1

7 bi

enni

um

$20.

6 m

illio

n fo

r tr

aditi

onal

OPI

; $6

mill

ion

for

the

disa

bilit

y pi

lot

Ann

ualiz

ed

budg

et:

$13.

3 m

illio

n (2

015–

17)

Aver

age

mon

thly

co

st p

er c

ase

is

$332

per

mon

th.d

a A 2

014

stud

y sh

owed

that

ove

r an

18-m

onth

per

iod,

onl

y 19

per

cent

of O

rego

n Pr

ojec

t Ind

epen

denc

e co

nsum

ers

conv

erte

d to

Med

icai

d se

rvic

es. S

ee O

rego

n D

epar

tmen

t of

Hum

an S

ervi

ces,

“Fa

ct S

heet

: Ore

gon

Proj

ect I

ndep

ende

nce,

” (S

alem

, OR

: Ore

gon

Dep

artm

ent o

f Hum

an S

ervi

ces)

, htt

ps:/

/olis

.leg.

stat

e.or

.us/

liz/2

017R

1/D

ownl

oads

/C

omm

itte

eMee

tingD

ocum

ent/

9847

9.

b For

peo

ple

with

inco

me

abov

e 15

0 pe

rcen

t of F

PL, f

ees

appl

y to

all

serv

ices

, exc

ept s

ervi

ce c

oord

inat

ion.

c Ore

gon

Dep

artm

ent o

f Hum

an S

ervi

ces,

“Fa

ct S

heet

: Ore

gon

Proj

ect I

ndep

ende

nce.

” d A

201

2 st

udy

foun

d th

at O

rego

n Pr

ojec

t Ind

epen

denc

e co

nsum

ers

use

24 p

erce

nt o

f the

ave

rage

hou

rs u

sed

by a

Med

icai

d be

nefic

iary

. Cite

d in

Ore

gon

Dep

artm

ent o

f Hum

an S

ervi

ces,

“2

017-

19 A

genc

y B

udge

t Req

uest

.”



PRO

GR

AM

N

AM

E

PRO

GR

AM

ST

AR

T D

ATE,

A

DM

INIS

TER

ING

A

GEN

CY

PUR

POSE

ELIG

IBIL

ITY

SER

VIC

ES, B

ENEF

IT

DES

IGN

, CO

ST

CO

NTA

INM

ENT

STR

ATEG

IES

(SER

VIC

E LI

MIT

ATIO

NS,

C

OST

CA

PS)

CA

SELO

AD

, W

AIT

LIS

TFU

ND

ING

, EX

PEN

DIT

UR

ES

CO

ST P

ER

PER

SON

SE

RV

ED

AG

E, C

LIN

ICA

L EL

IGIB

ILIT

Y/C

AR

E N

EED

S, A

SSES

SMEN

T PR

OC

ESS

FIN

AN

CIA

L EL

IGIB

ILIT

Y A

ND

C

OST

SH

AR

ING

Penn

sylv

ania

O

PTIO

NS

1990

Adm

inis

tere

d by

th

e D

epar

tmen

t on

Agi

ng

Loca

l ad

min

istr

atio

n by

A

AAs

OPT

ION

S is

par

t of

PEN

NC

ARE

.

PEN

NC

ARE

has

th

ree

prog

ram

s:

(a) O

PTIO

NS;

(b

) agi

ng

serv

ices

, whi

ch

incl

ude

mea

ls,

hom

e he

alth

, em

ploy

men

t se

rvic

es, a

nd

recr

eatio

n at

se

nior

cen

ters

; an

d (c

) att

enda

nt

care

for

pers

onal

ca

re s

ervi

ces

to a

dults

with

ph

ysic

al d

isab

ility

w

ho a

ge o

ut fr

om

the

atte

ndan

ce

care

pro

gram

, w

hich

ser

ves

indi

vidu

als

unde

r ag

e 60

HC

BS p

rogr

am

for

cons

umer

s ag

es 6

0+ to

as

sist

them

in

mai

ntai

ning

in

depe

nden

ce

with

the

high

est l

evel

of

func

tioni

ng in

th

e co

mm

unity

an

d to

del

ay th

e ne

ed fo

r m

ore

cost

ly s

ervi

ces

• A

ge 6

0+

• C

itize

n or

law

ful

perm

anen

t res

iden

t

• Ex

peri

ence

s so

me

degr

ee o

f fr

ailt

y—m

enta

lly o

r ph

ysic

ally

—th

at a

ffec

ts

daily

func

tion

• C

onsu

mer

s w

ho

rece

ive

OPT

ION

S se

rvic

e m

ust b

e as

sess

ed u

sing

Nee

ds

Ass

essm

ent T

ool (

NAT

) or

NAT

-Exp

ress

• M

ust r

ecei

ve c

are

man

agem

ent

serv

ices

—w

ith

the

exce

ptio

n of

in

divi

dual

s w

ho

rece

ive

tran

spor

tatio

n an

d N

on-C

ongr

egat

e/In

-Hom

e M

eals

onl

ye

• M

ay b

e cl

inic

ally

or

finan

cial

ly in

elig

ible

for

Med

icai

d LT

SS

• M

ay b

e as

sess

ed

with

a le

vel o

f car

e de

term

inat

ion

of

Nur

sing

Fac

ility

El

igib

le o

r In

elig

ible

• If

clin

ical

elig

ibili

ty fo

r nu

rsin

g fa

cilit

y ca

re

is m

et, t

hen

resi

dent

m

ust b

e fin

anci

ally

in

elig

ible

for

Med

icai

d

• N

o in

com

e or

re

sour

ce te

sts

for

elig

ibili

ty, b

ut

inco

me-

rela

ted

cost

sh

arin

g ap

plie

s

• Sl

idin

g sc

ale

fee

(2%

–98%

of s

ervi

ce

plan

cos

ts) a

pplie

s fo

r in

divi

dual

s w

ith

inco

me

> 1

33%

and

<

300

% o

f FPL

• Fu

ll co

st p

aid

by

cons

umer

abo

ve

300%

of F

PL

• C

ost s

hari

ng b

ased

on

cou

ntab

le

mon

thly

inco

me

(cou

ntab

le in

com

e ex

clud

es 3

0% fl

at

disa

llow

ance

for

Med

icar

e Pa

rt B

pr

emiu

ms,

food

st

amps

, LIH

EAP

paym

ents

, rev

erse

m

ortg

ages

)

• C

onsu

mer

s w

ith

coun

tabl

e in

com

e ab

ove

300%

of F

PL

pay

full

cost

s

• C

anno

t rec

eive

M

edic

aid

LTSS

• M

ust a

pply

for

Med

icai

d if

clos

e to

fin

anci

al e

ligib

ility

f

• M

anda

tory

M

edic

aid

Elig

ibili

ty

Det

erm

inat

ion

Proc

ess

does

not

ap

ply

to in

divi

dual

s w

ho n

eed

care

m

anag

emen

t or

in-h

ome

mea

l se

rvic

e (a

lone

or

in

com

bina

tion)

AA

As a

re r

equi

red

to o

ffer

the

follo

win

g O

PTIO

NS

serv

ices

:•

Car

e m

anag

emen

t

• In

-hom

e m

eal s

ervi

ce

• O

lder

adu

lt da

ily li

ving

se

rvic

es

• Pe

rson

al c

are

serv

ices

AA

As m

ay o

ffer

add

ition

al

serv

ices

acc

ordi

ng to

thei

r lo

cal p

olic

ies

as fu

nds

are

avai

labl

e:•

Emer

gent

ser

vice

s (f

or a

n im

med

iate

nee

d ow

ing

to a

cr

itica

l eve

nt s

uch

as c

over

se

rvic

es, o

vern

ight

she

lter,

or e

mer

genc

y su

pplie

s)

• H

ome

heal

th s

ervi

ces

• H

ome

mod

ifica

tions

($

15,0

00 li

mit)

• H

ome

supp

ort s

ervi

ces

(incl

udin

g as

sist

ance

with

IA

DLs

, lau

ndry

, sho

ppin

g,

mea

l pre

para

tion,

etc

.)

• Pe

rson

al e

mer

genc

y re

spon

se s

yste

m

• Pe

st c

ontr

ol/f

umig

atio

n

• Sp

ecia

lized

med

ical

tr

ansp

orta

tion

• Su

pple

men

tal s

ervi

ces

(whi

ch c

anno

t be

prov

ided

no

w b

ecau

se o

f the

wai

ting

list f

or c

ore

serv

ices

)

Tota

l peo

ple

serv

ed (2

017)

: 67

,436

Doe

s no

t mee

t nu

rsin

g fa

cilit

y le

vel o

f car

e:

59,1

56

Mee

ts n

ursi

ng

faci

lity

leve

l of

care

: 8,2

80

Wai

t lis

t: Y

es

Lott

ery

fund

s $3

36 m

illio

n fo

r al

l PEN

NC

ARE

pr

ogra

ms

OPT

ION

S:

Prim

arily

Agi

ng

Bloc

k G

rant

; lo

tter

y

$170

.6 m

illio

n in

201

7 (s

tate

+

fede

ral)

Car

e pl

an c

ost

cap

is $

765

per

mon

th.

Exce

ptio

ns m

ay

be g

rant

ed (i

n ra

re in

stan

ces)

.

$9,1

80 p

er y

ear

e Non

-Con

greg

ate/

In-H

ome

Mea

ls c

onsu

mer

s w

ill b

e as

sess

ed u

sing

the

Nee

ds A

sses

smen

t Too

l Exp

ress

, and

car

e m

anag

emen

t can

be

prov

ided

by

a ca

se a

ide

who

is s

uper

vise

d by

a c

are

man

ager

or a

car

e m

anag

emen

t sup

ervi

sor.

f Pen

nsyl

vani

a Po

licy

Proc

edur

e M

anua

l, A

ppen

dix

F.4,

(Har

risb

urg,

PA

: Pen

nsyl

vani

a D

epar

tmen

t of A

ging

, Nov

embe

r 19,

201

4), h

ttp:

//w

ww

.agi

ng.p

a.go

v/pu

blic

atio

ns/p

olic

y-pr

oced

ure-

man

ual/

Doc

umen

ts/A

ppx%

20F.

4%20

Fina

ncia

l%20

Thre

shol

d%20

for%

20M

anda

tory

%20

Med

ical

%20

Ass

ista

nce%

20El

igib

ility

%20

Det

erm

inat

ion%

20Pr

oces

s.pd

f.



PRO

GR

AM

N

AM

E

PRO

GR

AM

ST

AR

T D

ATE,

A

DM

INIS

TER

ING

A

GEN

CY

PUR

POSE

ELIG

IBIL

ITY

SER

VIC

ES, B

ENEF

IT

DES

IGN

, CO

ST

CO

NTA

INM

ENT

STR

ATEG

IES

(SER

VIC

E LI

MIT

ATIO

NS,

C

OST

CA

PS)

CA

SELO

AD

, W

AIT

LIS

TFU

ND

ING

, EX

PEN

DIT

UR

ES

CO

ST P

ER

PER

SON

SE

RV

ED

AG

E, C

LIN

ICA

L EL

IGIB

ILIT

Y/C

AR

E N

EED

S, A

SSES

SMEN

T PR

OC

ESS

FIN

AN

CIA

L EL

IGIB

ILIT

Y A

ND

C

OST

SH

AR

ING

Penn

sylv

ania

C

areg

iver

Su

ppor

t Pr

ogra

m

1990

Dep

artm

ent o

f A

ging

Loca

l ad

min

istr

atio

n by

A

AAs

To p

rovi

de

finan

cial

as

sist

ance

to

prim

arily

qu

alifi

ed

care

give

rs

who

ass

ist

depe

nden

t low

-in

com

e ol

der

adul

ts

Indi

vidu

als

who

car

e fo

r a

spou

se, r

elat

ive,

or

frie

nd

who

req

uire

s as

sist

ance

ow

ing

to d

isea

se o

r di

sabi

lity.

The

pro

gram

al

so s

uppo

rts

indi

vidu

als

ages

55

and

olde

r w

ho

are

carin

g fo

r re

late

d ch

ildre

n.

Fina

ncia

l ass

ista

nce

avai

labl

e to

qua

lified

ca

regi

vers

bas

ed o

n in

com

e. H

ouse

hold

s w

ith in

com

es u

p to

200

% o

f FPL

are

el

igib

le fo

r 10

0% o

f th

e m

axim

um b

enefi

t.

The

bene

fit d

ecre

ases

by

10%

for

ever

y 20

%

incr

ease

in in

com

e.

Hou

seho

lds

with

in

com

es a

bove

380

%

of F

PL a

re n

ot e

ligib

le

for

the

prog

ram

.

Reim

burs

es c

areg

iver

s up

to $

200

per

mon

th fo

r ou

t-of

-poc

ket e

xpen

ses

on

serv

ices

and

sup

plie

s. It

can

be

use

d fo

r re

spite

car

e,

tran

spor

tatio

n, in

cont

inen

ce

supp

lies,

and

edu

catio

n an

d co

unse

ling

for

care

give

rs.

Prov

ides

one

-tim

e gr

ants

of

up

to $

2,00

0 fo

r ho

me

mod

ifica

tions

and

ass

istiv

e de

vice

s, in

clud

ing

whe

elch

air

ram

ps, g

rab

bars

, and

cha

ir lif

ts

5,25

6 fa

mili

es

in F

Y 20

17/

18To

tal i

n 20

17/

18

= $

17.1

mill

ion

$12.

1 m

illio

n fr

om th

e lo

tter

y,

whi

ch is

an

over

mat

ch;

rem

aind

er c

omes

fr

om th

e O

lder

A

mer

ican

s Ac

t

$200

per

mon

th;

one-

time

gran

t of

$2,0

00 fo

r ho

me

mod

ifica

tions

an

d as

sist

ive

tech

nolo

gy

Was

hing

ton

Med

icai

d A

lter

nati

ve

Car

e (M

AC

)g

Laun

ched

Se

ptem

ber

2017

Dep

artm

ent o

f So

cial

and

Hea

lth

Serv

ices

To s

uppo

rt

unpa

id

care

give

rs w

ho

are

avoi

ding

or

del

ayin

g th

e ne

ed fo

r m

ore

inte

nsiv

e M

edic

aid-

fund

ed s

ervi

ces

For

unpa

id c

areg

iver

s ca

ring

for

a M

edic

aid-

elig

ible

per

son

who

m

eets

nur

sing

hom

e le

vel

of c

are

Indi

vidu

al m

ust b

e ag

e 55

+, l

ive

in a

hom

e se

ttin

g, a

nd b

e a

stat

e re

side

nt

Indi

vidu

als

who

are

el

igib

le fo

r M

edic

aid

but n

ot c

urre

ntly

usi

ng

Med

icai

d-fu

nded

LTS

S

No

cost

sha

ring

or

esta

te r

ecov

ery

Up

to $

573

per

mon

th in

as

sist

ance

. Peo

ple

who

ch

oose

ser

vice

s m

ust m

ake

a ch

oice

bet

wee

n re

ceiv

ing

this

pro

gram

’s se

rvic

es o

r tr

aditi

onal

LTS

S se

rvic

es,

such

as

thos

e in

the

Med

icai

d H

CBS

wai

ver

or C

omm

unity

Fi

rst C

hoic

e.

57Bi

lled

serv

ices

in

firs

t yea

r:

$35,

437

Abo

ut $

350

per

mon

th

g Mon

thly

cas

eloa

d pr

ojec

tions

for M

AC a

nd T

SOA

are

1,34

8 in

201

8; 5

,315

in 2

020;

and

6,9

06 in

202

1. T

otal

fund

ing

for t

he M

AC a

nd T

SOA

dem

onst

ratio

n, in

clud

ing

serv

ices

and

ad

min

istr

atio

n, is

$19

.5 m

illio

n in

201

8; $

37.2

mill

ion

in 2

019;

$53

.7 m

illio

n in

202

0; a

nd $

57.9

mill

ion

in 2

021.

Giv

en h

ow n

ew th

is d

emon

stra

tion

is, s

tate

adm

inis

trat

ors

are

revi

ewin

g th

e ta

rget

s in

ligh

t of t

he fi

rst y

ear’s

act

uals

and

det

erm

inin

g re

ason

able

pro

ject

ions

goi

ng fo

rwar

d. S

ourc

e: E

mai

l and

pho

ne in

terv

iew

com

mun

icat

ions

with

Was

hing

ton

Agi

ng a

nd L

ong-

Term

Su

ppor

t Adm

inis

trat

ion,

Oct

ober

201

8.



PRO

GR

AM

N

AM

E

PRO

GR

AM

ST

AR

T D

ATE,

A

DM

INIS

TER

ING

A

GEN

CY

PUR

POSE

ELIG

IBIL

ITY

SER

VIC

ES, B

ENEF

IT

DES

IGN

, CO

ST

CO

NTA

INM

ENT

STR

ATEG

IES

(SER

VIC

E LI

MIT

ATIO

NS,

C

OST

CA

PS)

CA

SELO

AD

, W

AIT

LIS

TFU

ND

ING

, EX

PEN

DIT

UR

ES

CO

ST P

ER

PER

SON

SE

RV

ED

AG

E, C

LIN

ICA

L EL

IGIB

ILIT

Y/C

AR

E N

EED

S, A

SSES

SMEN

T PR

OC

ESS

FIN

AN

CIA

L EL

IGIB

ILIT

Y A

ND

C

OST

SH

AR

ING

Was

hing

ton

Tailo

red

Supp

orts

for

O

lder

Adu

lts

(TSO

A)

Laun

ched

Se

ptem

ber

2017

Dep

artm

ent o

f So

cial

and

Hea

lth

Serv

ices

Supp

orts

old

er

indi

vidu

als

and

thei

r fa

mili

es to

av

oid

or d

elay

im

pove

rishm

ent

To p

rovi

de s

ervi

ces

and

supp

orts

to in

divi

dual

s ag

es 5

5 an

d ol

der

with

low

inco

mes

who

cu

rren

tly d

o no

t mee

t M

edic

aid

finan

cial

re

sour

ce e

ligib

ility

cr

iteria

but

do

mee

t fu

nctio

nal c

riter

ia fo

r ca

re

Inco

me

limit

of

300%

of t

he F

eder

al

Bene

fit R

ate

or

$2,2

50 p

er m

onth

for

a si

ngle

indi

vidu

al.

If an

app

lican

t is

mar

ried,

the

inco

me

of th

e sp

ouse

is n

ot

cons

ider

ed.

The

asse

t lim

it fo

r a

sing

le in

divi

dual

is

$53

,100

, and

m

arrie

d co

uple

s ca

n ha

ve a

sset

s up

to

$108

,647

.

Som

e as

sets

not

co

unte

d to

war

d th

is

limit

and

incl

ude

one’

s ho

me,

reg

ardl

ess

of

equi

ty v

alue

; hom

e fu

rnis

hing

s; a

veh

icle

; an

d bu

rial f

unds

up

to $

1,50

0 fo

r th

e ap

plic

ant a

nd $

1,50

0 fo

r hi

s or

her

spo

use

Up

to $

573

per

mon

th in

as

sist

ance

; may

incl

ude

the

follo

win

g be

nefit

s an

d se

rvic

es:

• A

dult

day

care

/adu

lt da

y he

alth

• C

areg

iver

trai

ning

and

ed

ucat

ion

(for

Alz

heim

er’s

ca

regi

vers

)

• C

ouns

elin

g/su

ppor

t gro

ups

• H

ome

mod

ifica

tions

, suc

h as

the

addi

tion

of g

rab

bars

or

whe

elch

air

ram

ps

• H

ouse

keep

ing/

erra

nds

• In

form

atio

n re

gard

ing

care

givi

ng

• M

eal d

eliv

ery

• Pe

rson

al e

mer

genc

y R

espo

nse

syst

ems

• R

espi

te c

are

• Sp

ecia

lized

med

ical

eq

uipm

ent/

supp

lies

• Tr

aini

ng—

assi

sts

care

give

rs

in g

aini

ng k

now

ledg

e an

d sk

ills

to p

rovi

de c

are

• Tr

ansp

orta

tion—

for

deliv

ery

of s

ervi

ces

• Pe

rson

al c

are

assi

stan

ce

and

nurs

e de

lega

tion,

su

ch a

s m

edic

atio

n ad

min

istr

atio

n an

d te

stin

g of

blo

od g

luco

se le

vels

, in

pla

ce o

f res

pite

car

e,

avai

labl

e fo

r se

nior

s w

ho

do n

ot h

ave

an u

npai

d ca

regi

ver

616

fam

ily

care

give

rs/

indi

vidu

als

(dya

d)

1,54

9 in

divi

dual

s

Bille

d se

rvic

es in

fir

st y

ear:

$495

,763

(f

or d

yads

)

$1.5

mill

ion

(f

or in

divi

dual

s)

Abo

ut $

350

per

mon

th



PRO

GR

AM

N

AM

E

PRO

GR

AM

ST

AR

T D

ATE,

A

DM

INIS

TER

ING

A

GEN

CY

PUR

POSE

ELIG

IBIL

ITY

SER

VIC

ES, B

ENEF

IT

DES

IGN

, CO

ST

CO

NTA

INM

ENT

STR

ATEG

IES

(SER

VIC

E LI

MIT

ATIO

NS,

C

OST

CA

PS)

CA

SELO

AD

, W

AIT

LIS

TFU

ND

ING

, EX

PEN

DIT

UR

ES

CO

ST P

ER

PER

SON

SE

RV

ED

AG

E, C

LIN

ICA

L EL

IGIB

ILIT

Y/C

AR

E N

EED

S, A

SSES

SMEN

T PR

OC

ESS

FIN

AN

CIA

L EL

IGIB

ILIT

Y A

ND

C

OST

SH

AR

ING

Was

hing

ton

Fam

ily

Car

egiv

er

Supp

ort

Prog

ram

1989

Dep

artm

ent o

f So

cial

and

Hea

lth

Serv

ices

Loca

l ad

min

istr

atio

n by

A

AAs

To s

uppo

rt

unpa

id fa

mily

ca

regi

vers

, so

they

may

co

ntin

ue to

pr

ovid

e ca

re to

th

eir

love

d on

es

Car

egiv

ers

and

care

re

ceiv

ers

mus

t be

at le

ast

18 y

ears

old

. Car

egiv

ers

are

asse

ssed

usi

ng th

e ev

iden

ce-b

ased

TC

ARE

®

Asse

ssm

ent p

roce

ss.

Elig

ibili

ty fo

r se

rvic

es is

de

term

ined

by

TCA

RE®

bu

rden

sco

res

and

the

amou

nt o

f tim

e sp

ent

care

givi

ng.

Serv

ices

targ

eted

to

low

er-in

com

e fa

mili

es; c

ost s

harin

g on

a s

lidin

g sc

ale

appl

ies

only

to th

ose

who

rec

eive

res

pite

se

rvic

es a

nd h

ave

inco

mes

abo

ve th

e st

ate

med

ian

inco

me

Prov

ides

ser

vice

s to

unp

aid

care

give

rs w

ho p

rovi

de

supp

orts

to a

dults

usi

ng

evid

ence

-bas

ed T

CA

RE®

to

asse

ss th

e bu

rden

s, s

tres

ses,

an

d up

lifts

exp

erie

nced

by

care

give

rs, t

o gu

ide

the

choi

ce o

f int

erve

ntio

ns,

such

as

trai

ning

/ed

ucat

ion,

co

unse

ling,

res

pite

, eq

uipm

ent/

supp

lies,

and

w

elln

ess

ther

apie

s

5,46

0$1

1 m

illio

n st

ate

fund

ing

$3 m

illio

n O

lder

A

mer

ican

s Ac

t Ti

tle 3

E

Aver

age:

$2,

564/

year

Was

hing

ton

Seni

or

Cit

izen

s’

Serv

ices

Act

1977

Dep

artm

ent o

f So

cial

and

Hea

lth

Serv

ices

Prov

ides

old

er

indi

vidu

als,

re

gard

less

of

inco

me,

with

in-

hom

e se

rvic

es

to h

elp

them

st

ay in

thei

r ow

n ho

mes

, to

prom

ote

self-

dete

rmin

atio

n an

d ag

ing

in

plac

e

Fund

ing

also

use

d to

m

atch

Old

er

Am

eric

ans

Act

fund

ing

Elig

ible

indi

vidu

als

are

ages

65+

; OR

ages

60+

, an

d ei

ther

une

mpl

oyed

or

wor

king

20

hour

s a

wee

k or

less

AN

D

They

mus

t als

o ha

ve

a ph

ysic

al, m

enta

l, or

ot

her

type

of i

mpa

irmen

t, w

hich

with

out s

ervi

ces

wou

ld p

reve

nt th

em fr

om

rem

aini

ng in

thei

r ho

me

Nee

d de

term

ined

loca

lly

and

serv

ices

ava

ilabl

e va

ry b

y A

AA

Non

exem

pt r

esou

rces

no

t to

exce

ed

$10,

000

for

a si

ngle

pe

rson

or

$15,

000

for

a fa

mily

of t

wo,

in

crea

sed

by $

1,00

0 fo

r ea

ch a

dditi

onal

fa

mily

mem

ber

of th

e ho

useh

old

Inco

me

at o

r be

low

40

% o

f the

sta

te

med

ian

inco

me

will

ha

ve s

ervi

ces

with

out

cost

sha

ring;

a s

lidin

g-fe

e ba

sis

avai

labl

e fo

r th

ose

with

hig

her

inco

mes

Det

erm

ined

loca

lly b

y th

e A

AA

Som

e se

rvic

es p

rovi

ded

at n

o ch

arge

reg

ardl

ess

of in

com

e or

nee

d re

quire

men

ts. T

hese

se

rvic

es in

clud

e, b

ut a

re n

ot

limite

d to

, nut

ritio

nal s

ervi

ces,

he

alth

scr

eeni

ng, a

nd a

cces

s se

rvic

es.

Abo

ut 6

,000

$8,4

17,4

81 s

tate

fu

nds

Hig

hly

varia

ble

elbaliavt Ao

A =

NN



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