HD42 - Medicaid Coverage of Therapeutic or Personal Care for Adults and Children

  • Published: 1992
  • Author: Department of Medical Assistance Services
  • Enabling Authority: House Joint Resolution 368 (Regular Session, 1991)

Executive Summary:
House Joint Resolution 368 requested the Department of Medical Assistance Services to study the feasibility of Medicaid coverage of personal foster care for adults and children who would otherwise have to be admitted to nursing facilities at Medicaid expense. This document. contains the results of that study. The first two sections of this report describe how the study was conducted and give an overview of Medicaid requirements which affect any evaluation of the expansion of Medicaid coverage. The report then is divided into adult and children's foster care. The section on adult foster care describes adult foster home programs and funding models used around the nation. The sections of the report dealing with children report on foster care directed toward the treatment of emotionally disturbed children and foster care for children with medical needs.

ADULT FOSTER CARE

This study identifies four funding models of adult foster care programs:

• Massachusetts' Medicaid state plan option program,

• Oregon's Medicaid home and community-based care waiver program,

• Virginia's state and locally funded program, and

• The potential of a new model pursuant to Section 1929 of the Social Security Act which will permit federal matching funds for personal care services in adult foster homes.

The type of foster care for adults does not vary widely across the nation. Almost all programs serve physically or mentally dependent adults who require a safe place to live and provide room and board, supervision and personal care services. Personal care services are those services directed to assist an individual with the performance of activities of daily living such as bathing, dressing, toileting and eating.

States which fund adult foster care through state and local funds only have the greatest flexibility to design and manage their programs. If Medicaid funding is used, the services may be covered:

• As an optional service under the State Plan for Medical Assistance, or

• Through a home and community-based care waiver.

If covered as an optional service, a state is legally required to offer the service to all Medicaid eligible individuals who need it. If offered through a waiver, a state may limit the service to those individuals who otherwise would be served in a nursing home at equal or lower cost. The cost impact of the two options may vary greatly.

The recommendations concerning adult foster care are based on the findings that:

• Virginia's current state and locally funded program does not allow Virginia to bring in additional funding through Medicaid;

• Coverage of adult foster care under Medicaid as a state plan option service could result in additional cost to the Commonwealth in a time of extreme fiscal constraint;

• Implementation of payment for personal care services in adult foster homes under Section 1929 of the Social Security Act presents substantial financial risk to the Commonwealth at this time;

• Permitting coverage of personal care services in an adult foster home through a home and community-based waiver would permit Medicaid expansion into another service program without increasing the number of eligible Medicaid recipients or the total amount expended by the Commonwealth, and even save state funds if the localities were required to continue to participate in funding adult foster care following the conversion of these services to a Medicaid home and community-based waiver program.

Recommendations:

1. Amend the current Medicaid home and community-based care waiver for the elderly and disabled to permit provision of personal care services when the Medicaid-waiver eligible client is residing in an approved adult family/foster care home.

2. Explore the feasibility of allowing foster care homes to be enrolled as personal care providers.

3. Await the publication of the federal regulations implementing Section 1929 of the Social Security Act before consideration is given to including personal care as an optional service under the State Plan for Medical Assistance.

4. Request the Secretary of Health and Human Resources to study adult foster/family home approval procedures and requirements to determine if they need to be revised to assure statewide uniformity and to assure that the requirements are coordinated with other long-term care community services before allowing Medicaid payments to be made directly to adult foster/family homes.