173069 Personal Care Services for the Disabled: A National Study of Trends in Programs and Policies

Sunday, October 26, 2008

Terence Ng, MA , Depratment of Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA
Charlene Harrington, PhD , Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA
Consumer demand, the Supreme Court's Olmstead decision, and policies such as the Presidents' New Freedom Initiative place pressure on state long-term-care (LTC) systems to extend home and community-based (HCB) personal care services. At the same time, 43 states report budget deficits and institutional long-term care provision (e.g., in nursing homes) continues to consume 60 percent of total Medicaid LTC expenditures. Previous studies of HCB services have given limited attention to formal personal care services that help people with disabilities and chronic conditions to live independently. Although the federal government spent $45 billion on personal care for people living at home in 2004, it is estimated that 21 percent of adults residing in the community have unmet need. Thus, the expansion of personal care is a pressing policy concern and there is a critical need for information on program and policy trends.

This paper draws from a unique national survey database to presents the latest available program and policy trends (1999-2005) on the three main programs that deliver personal care: the Medicaid state plan personal care service (PCS) optional benefit, Medicaid 1915(c) HCBS waivers, and Older Americans Act Title III. The program data indicate that growth rates in participants and expenditures are generally flat, and are slowing in some states. Findings from the policy survey show that more than 50 percent of states now use cost caps on their PCS program and an increasing number of personal care waivers operate waiting lists.

Learning Objectives:
From this session participants will be able to: (1) identify latest trends in the formal personal care program participants and expenditures, (2) understand state responses to fiscal crises in terms of formal personal care program trends, and (3) consider the potential impact on access to Medicaid personal care for the disabled.

Keywords: Personal Assistance, Home Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an author on the paper
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.