The Personal Care Option under Medi-Caid
Deborah Kaplan, World Institute on Disability
510 16th St.
Oakland, CA  94612-1500
http://www.wid.org


Introduction
? This presentation will provide an overview of the PC Option:
? Pro's and Con's
? How States Use the PC Option
? Strategic features of a state program



Overview of the PC Option
? Title XIX of Medicaid (same as waivers)
? PC-Option means that states have the option to include personal care services (Personal Assistance Services or PAS) in the state's Medicaid program - it's not mandatory
? States can define services and design the program with very few federal restrictions



Overview of the PC Option
? 3 Federal requirements:
provided in the home or other location as defined by state
authorized by a physician or by a state service plan 
provided by a qualified individual who is not a spouse or parent (this can be circumvented)


Overview of the PC Option
? states can determine how these requirements will be implemented (I.e., degree of kinship that excludes a family member from providing services
? all eligible clients must be served - no waiting lists
? money can't go directly to client



Pro's
? States can't limit the number of eligible clients to a set number (i.e., 100 people only)
? Must be statewide
? States can leverage federal money  through this option (like waivers)
? No constraints on consumer control
? The PC Option serves a much larger number of people than other programs 
Con's
? States are afraid to create an open-ended eligibility program - less fiscally predictable
? The program that a state creates might leave out many of the people who need PAS
? States have discretion to limit hours, services, over-medicalize services


Con's
? No mandated priority for people coming out of nursing homes and institutions
? Tied to poverty-level income


How States Use the PC Option
? 32 states include PAS as an optional service
? 25 states have a PC Option and also have waiver programs 
? 18 states do not include PAS as an option


Strategic Features of a State Program (What to look out for!)  - Eligibility
? Income eligibility: A state can use the SSI Income standard or can allow a Medically Needy Spend Down  
? All ages are eligible, but implementation practices such as outreach may operate to exclude people in certain age groups
? Children with significant disabilities have to be served
? Degree of disability: ADL's  determine numbers of hours or type of services needed


Strategic Features of a State Program - Services Provided
? Personal Care services must be provided - but breadth of coverage is discretionary - each state can decide:
? Household Maintenance services?
? Communication services?
? Transportation services?
? Short-term services?
? Workplace services?


Strategic Features of a State Program - Availability and Intensity of Services
? Hour limits can make services unrealistic for people with most significant disabilities
? Dollar limits can also keep services too low to reach all who might need them
? Availability of services - the best is 24hrs 7 days a week
? Outreach makes a difference!





Strategic Features of a State Program - Types of Providers
? Agencies - profit or non-profit
? Emergency Services - variant of agency
? Independent - employed by recipient or by state for withholding 
? Government - civil service or contract 
? Public Authority - collective bargaining agent (in California)
? wages and benefits to workers are especially important


Strategic Features of a State Program - Quality Assurance
? State level oversight - does the State monitor?
? Case level oversight - who takes complaints?
? Provider screening and training - what are criteria? What is curriculum?
? Recipient complaint process?


Conclusion
? PC Option has the potential to provide broadest range of services to the broadest number of people who need PAS
? Without a federal mandate, actual state programs often fall short of this potential
? Strong cross-disability coalitions can influence program design - follow the strategic features!



Questions for discussion
? Which state currently use the PC Option?  What's your experience?
? What is experience of advocates who have promoted PC Option in states that don't have it?
? What arguments or tactics work?
? How do we promote consumer control under this option?
















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