Implications of State Methods for Offering Personal Assistance Services. Medicaid Policy Brief 18.

摘要

The Medicaid program has a long history of federal initiatives to encourage states to make community-based long-term services and supports more accessible to Medicaid enrollees who are frail or have disabilities. These efforts began with the establishment of the section 1915(c) waiver program in 1981. This program allows states to target home- and community-based services (HCBS) to select populations or regions. The Centers for Medicare & Medicaid Services (CMS) has complemented this waiver program with infrastructure transformation grants and Real Choice Systems Change grants to help states address large structural and organizational issues that impede HCBS provision; however, these grants focus on setting the stage for change and the initial implementation steps of a rebalancing strategy. In 2007, the Money Follows the Person (MFP) demonstration grant program established another financial mechanism that states could use to work on rebalancing their long-term care programs.