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In Brief: The Medicaid Personal Care Services Benefit: Practices in States that Offer the Optional State Plan Benefit

by Enid Kassner, AARP Public Policy Institute, Public Policy Institute, August 2005

This and Related Reports

Introduction and Purpose

This In Brief summarizes the findings of the AARP Public Policy Institute (PPI) issue paper, The Medicaid Personal Care Services Benefit: Practices in States that Offer the Optional State Plan Benefit. This paper was based on a survey of the 26 states and the District of Columbia that use the Medicaid personal care services option for adults as a state plan benefit. "Personal care services" (PCS) is a term generally used to describe the type of "hands-on" or individualized assistance with everyday activities that some people with disabilities need in order to live independently in the community rather than in an institutional setting.

Key Findings

Twenty-three states and the District of Columbia (henceforth referred to as a state) responded to the survey, for a total of 24 respondents. Two states — Alaska and West Virginia — declined to participate in the survey. California provided information only about the number of beneficiaries and spending for the benefit, raising the total number of respondents in those categories to 25. Data on the number of beneficiaries and program expenditures are for 2003; all other data in the report are for 2004.

Beneficiaries

  • Respondents from 25 states reported that almost 700,000 beneficiaries of all ages received personal care services in state fiscal year 2003.
  • Only five respondents had sufficient data to provide complete information about the composition of the population receiving PCS benefits by category. In all five states — the District of Columbia, Montana, North Carolina, Oklahoma, and South Dakota — the largest proportions of beneficiaries were elderly.

Program expenditures

  • Reported expenditures for the PCS benefit in 25 states totaled $6.3 billion.
  • There is substantial variation in expenditures for the program across the states, reflecting the size of the programs and the design of the benefit. The range was from $2.2 billion in California to $661,000 in New Hampshire.
  • Estimates of the cost per beneficiary for the PCS benefit ranged from more than $10,000 in eight states — Massachusetts, Minnesota, New Hampshire, New Jersey, New Mexico, New York, Washington, and Wisconsin — to less than $1,500 in Oregon and South Dakota.

Eligibility determinations

  • The need for assistance with activities of daily living is the criterion used most commonly to assess functional eligibility for the PCS benefit.
  • More than three-quarters of respondents — 79 percent, or 19 states — report that the functional eligibility criteria for the optional PCS benefit are less restrictive than the criteria used for nursing facility admission in the state.

Settings for service delivery

  • Four states — 17 percent — report that personal care services can be provided only in the home. Other respondents note that the services can be provided in community-based residential settings and in other settings where the need occurs, such as in the workplace, at a relative’s home, or at a senior center.

Covered services

  • States were asked to indicate whether assistance with particular activities was covered under the optional PCS benefit. Each of the states provides help related to bathing, dressing, toileting, and laundry, and most cover assistance with eating, transferring or positioning, ambulation, grooming, shopping, housekeeping, and meal preparation.
  • Assistance with medication management is also common, provided by 17 states, or 71 percent

Service limits

  • Some 63 percent of respondents — 15 states — say that the state limits the number of hours of service that can be provided. States differ with regard to how the hours of services are limited: on a weekly, monthly, or annual basis.

Consumer direction

  • Overall, 71 percent of states — 17 states — allow consumer direction for the personal care services benefit.

Conclusion

Personal care services are vitally important to many people with disabilities who wish to remain in the community but need assistance with everyday activities. All states use a variety of sources of public funding to finance personal care services, but the Medicaid program is by far the largest source of funding. With the trend toward providing more community-based care as an alternative to institutional care, the optional Medicaid PCS benefit continues to play an important role in ensuring that people with disabilities can remain in the community.

Footnotes

  1. Summer, Laura L., and Emily S. Ihara. PPI Issue Paper #2005-11. August 2005.

Written by Enid Kassner, AARP Public Policy Institute
August 2005
©2005 AARP
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