Promising Programs in Texas
Kitchener, M., Ng, T., Willmott, M., Harrington, C. (2006) The Texas Medicaid State Plan Personal Care Services Program. Center for Personal Assistance Services, University of California, San Francisco, CA.
This case study of the Texas Medicaid Primary Health Care (PHC) program highlights five interesting features. First, the PHC program is one of the oldest and largest Medicaid state plan PCS programs in the nation. Over time, it has displayed the flexibility to expand significantly and to adopt new practices such as consumer directed services (CDS).
Second, Texas' use of Medicaid 1929(b) authority allows persons with income up to 300 percent of the federal SSI level to receive identical services to PHC participants within the Community Assistance Services program which operates alongside the PHC benefit.
Third, the PHC program operates a two-tier system of costs controls. While 'priority' clients with higher needs are ensured continuity of care, they receive a maximum of 42 hours of care per week. Somewhat paradoxically, other clients receive a maximum of 50 hours a week of services (but may go without services for up to two weeks).
Fourth, the early implementation of CDS as an option within the PHC program underscores the need to ensure adequate training of case workers to explain consumer directed options to clients. Without this, case managers may not explain all available service delivery choices to clients and take-up may be reduced.
Fifth, initial take-up of CDS was higher among younger groups and lower among elderly persons wary of administrative burden. Thus, the results of Texas' pilot study of a hybrid CDS model (that allows consumers to select, train and supervise their attendant but leaves the fiscal, personnel and backup staffing responsibilities with the provider agency) will be interesting to monitor.
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