RD329 - Delivery of Home and Community-Based Services through the Medicaid State Plan and the §1915(i) State Plan Option - November 2010


Executive Summary:
House Joint Resolution No. 83 of the 2010 Virginia General Assembly requested that the Joint Legislative Audit and Review Commission study the potential costs and benefits of offering Medicaid home and community-based long-term care services (HCBS) through the State Plan for Medical Assistance (Appendix A). While the resolution was tabled in sub-committee, the Virginia Department of Medical Assistance Services (DMAS) agreed to study the potential implication of providing HCBS through the State Plan.

The Virginia Department of Medical Assistance Services provides medical and long-term care services to over 900,000 Virginians. Over 27,745 of these individuals rely on Medicaid-funded HCBS to provide the long-term care services they need in order to remain in their homes and communities and avoid institutionalization. In Virginia, these supportive services are provided through §1915(c) HCBS waiver programs. §1915(c) waivers are available to Virginians through a special agreement between the Department and the Centers for Medicare and Medicaid Services (CMS).

§1915(c) waiver programs enable the Department to provide an array of services to Virginians with specific conditions, such as intellectual disabilities or HIV/AIDS, and provide general supportive services to individuals who are elderly or have physical disabilities. §1915(c) waiver programs, however, have significant limitations. This report highlights two specific limitations of the §1915(c) waiver programs: the requirement that individuals must qualify for institutional care before accessing HCBS; and, the significant administrative burden of maintaining federal authority for the §1915(c) waiver programs. The report further discusses whether the Commonwealth can resolve these limitations through alternatives such as providing HCBS services through the State Plan for Medical Assistance or utilizing the new §1915(i) State Plan Option which was recently allowed through changes in federal law.

After research and analysis on these alternatives, evaluation of Departmental budget projections, and conversations with staff from CMS, it is apparent that given the current fiscal climate, resolving challenges within the §1915(c) waiver programs by moving services to the State Plan or utilizing the §1915(i) State Plan Option is not likely. Unless further changes in federal law occur, the fiscal impact of such a move combined with the continued administrative requirements for the provision of these services leads DMAS to conclude that these options may be unattractive to the Commonwealth at this time.