Policy Issues Affecting the Medicaid Personal Care Services Optional Benefit

摘要

The study analyzes how states are using the Medicaid Personal Care ServicesOptional (PC-Option) benefit. Under the PC-Option, states may choose to include personal care services in their state Medicaid plans, but are not required to do so. The only federal requirements for the PC-Option are that personal care services be: (1) provided in the home, (2) authorized by a physician in accordance with the recipient's treatment plan, (3) supervised by a registered nurse, and (4) provided by a qualified individual who is not a member of the recipient's family. The first requirement has been modified by federal legislation passed in 1990 which allows states to offer services outside the home by 1994. There is great variability among states on interpretation of the other requirements. The states determine how physician authorization is obtained and what constitutes a treatment plan. States also determine the nature and scheduling of R.N. supervision, set qualifications for providers, and determine what types of family members are excluded from becoming paid service providers.