Home and Community PAS Based Programs Personal assistant placing items on a high shelf


About this project

Recent studies have begun to describe the breadth and depth of Medicaid Home and Community Based Services (HCBS) programs more fully and although HCBS expenditures have increased rapidly from 1992 through 2006, states are facing serious budget problems which can jeopardize access to and funding for HCBS. This research project, which is directed by Terence Ng and Charlene Harrington at the University of California, San Francisco, is concerned with tracking changes and identifying gaps in these programs and services.

For the Center's purposes, the definition of the Home and Community Based Services includes:

All formal (paid) services delivered in the home and community, as opposed to institutional settings. These include personal assistance services, home health, waiver programs and other services funded by federal and state government. This research area has two goals.The primary goal of this five-year research project is with tracking changes and identifying gaps in HCBS programs and services. It comprises of three streams of research:

  • Track and analyze trends in HCBS participants, services, and expenditures in state programs over time. Study conducted by Terence Ng and Charlene Harrington at UCSF. We will expand our existing state database on PAS, HCBS waiver programs, and home health services for 2007-2011 by collecting data annually from states.
  • Track and analyze federal and state initiatives related to the Olmstead decision, waiting lists, Olmstead litigation, and other initiatives. Study conducted by Terence Ng and Alice Wong at UCSF.
  • Track and analyze state PAS policies and barriers to PAS policies. This study will update 2004-2007 state policy data and barriers for 2008-12 on issues such as cost containment policies, eligibility standards, and consumer directed services. This study is being conducted by Terence Ng and Charlene Harrington at UCSF.

A second goal is to develop effective evidence-based interventions to address the needs for PAS. Three projects address interventions.

  • Track and analyze state PAS interventions strategies and factors that impact expanding PAS. Study conducted by Charlene Harrington, Terence Ng, Martin Kitchener, and Nancy Miller.
  • Examine the cost effectiveness of Medicaid HCBS waivers as an evidence-based intervention to provide PAS. Study conducted by Terence Ng, Charlene Harrington, Martin Kitchener, and Nancy Miller.
  • Create a comprehensive state level databasee on registries and other intermediaries and evaluate their effectiveness in addressing unmet needs for PAS. Study conducted by Dorie Seavey and Abby Marquand at PHI

Promising Programs

The Center for Personal Assistance Services is conducting a study of Medicaid Optional State Plan Personal Care Services (PCS) programs. The study involves two main activities. First, better practices (e.g., consumer direction) are identified from the literature to use as criteria for selecting promising programs. Second, detailed case studies are conducted on the promising programs.

State by State Home and Community-Based PAS Data Available Map of the United States

State Medicaid 1915(c) HCBS Waiver Contact Info and Descriptions

Find contact information and learn about each Medicaid 1915(c) HCBS waiver in any state.

The 1999 Olmstead Supreme Court Decision

In a landmark interpretation of the ADA (Americans with Disabilities Act), the Supreme Court decided that people with disabilities have a right to receive care in the most integrated setting appropriate and that unnecessary institutionalization violates the ADA. All states must now comply with the decision. The Center for PAS is tracking the legal and policy ramifications of the Olmstead decision in each state.

State by State Medicaid Home and Community-Based Services for 2009

Find the total amount of expenditures, expenditures per 1,000 population, the number of participants, and the participants per 1,000 population for various Medicaid HCBS programs: Home Health, Personal Care Services, and the 1915(c) HCBS Waivers. Compare these data with US totals.

State by State Medicaid 1915(c) HCBS Waiver Data for 2009

Find the total amount of expenditures, expenditures per 1,000 population, the number of participants, and the participants per 1,000 population for several waiver target groups. Compare these data with US totals.

State by State Wages for Personal Care Aides, 2000 - 2010

Provides information on the wages received by Personal and Home Care Aides in all 50 states, the District of Columbia and the nation over a 10 year period.

PAS Funding by State:

Federal funding

Shows the total funding by state from the Older American's Act Title III Programs and Alzheimer's Disease Demonstration Grants.

State funding

State matched funding to some federally funded long-term care programs.

PAS Center publications

A list of reports and publications produced by the Home and Community-Based PAS project and its staff. The citations provide links to abstracts, press releases, and either the entire publication, or information about where to obtain it.

All PAS Center publications related to Home and Community-Based PAS

Recent additions

Kaye, H.S. (2012, December). Selected Inventory of Quality–of–Life Measures for Long–Term Services and Supports Participant Experience Surveys. University of California, San Francisco: Center for Personal Assistance Services.  Read more about the publication, Selected Inventory of Quality–of–Life Measures for Long–Term Services and Supports Participant Experience Surveys.

LaPlante, M.P. (2013). The Woodwork Effect in Medicaid Long-Term Services and Supports. Journal of Aging & Social Policy, 25:2, pp.161-180. doi: 10.1080/08959420.2013.766072 Read more about the publication, The Woodwork Effect in Medicaid Long-Term Services and Supports.

Kaye, H.S., & LaPlante, M.P. (2012, September). The Need for Personal Assistance Services. 2012 Center for Personal Assistance Services State of the Science Conference. San Francisco, CA: University of California, San Francisco.  Read more about the publication, The Need for Personal Assistance Services. 2012 Center for Personal Assistance Services State of the Science Conference.

Library

Citations and abstracts of important publications related to Home and community-based PAS. Information on how to obtain the complete text is provided with each citation.

All Home and Community-Based PAS publications

Recent additions

Centers for Medicare and Medicaid Service. (2013). Summary of Essential Elements of Managed Long Term Services and Supports Programs. Washington, DC: Author.  Read more about the publication, Summary of Essential Elements of Managed Long Term Services and Supports Programs.

Centers for Medicare and Medicaid Service. (2013, May). Guidance to States using 1115 Demonstrations or 1915(b) Waivers for managed Long Term Services and Supports Programs. Washington, DC: Author.  Read more about the publication, Guidance to States using 1115 Demonstrations or 1915(b) Waivers for managed Long Term Services and Supports Programs.

Wiener, J.M. (2013). After CLASS: The Long-Term Care Commission's Search For A Solution. Health Affairs, 32 (5), pp.831-834. doi: 10.1377/hlthaff.2013.0373 Read more about the publication, After CLASS: The Long-Term Care Commission´s Search For A Solution.

Presentations

Presentations given by the Home and Community-Based PAS project with links to abstracts, powerpoint files and summaries.

All Home and Community-Based PAS presentations

Recent additions

LaPlante, M., Harrington, C., Ng, T. & Kaye, H.S. (2011, Nov 19) The Affordable Care Act & Home and Community Based Service Options. Presented at the 64th Annual Scientific Meeting hosted by Gerontological Society of America.

Information about this event titled, 64th Annual Scientific Meeting | Download Powerpoint of this presentation titled, The Affordable Care Act & Home and Community Based Service Options

Ng, T., & Harrington, C. (2009, Nov 09) Medicaid Home and Community Based Services: Trends in Programs and Policies. Presented at the APHA Annual Meeting & Exposition hosted by American Public Health Association.

Read more about this presentation titled, Medicaid Home and Community Based Services: Trends in Programs and Policies

Ng, T., & Harrington, C. (2009, Nov 09) Personal Care Services for the Disabled: National Trends in Programs and Policies. Presented at the APHA Annual Meeting & Exposition hosted by American Public Health Association.

Read more about this presentation titled, Personal Care Services for the Disabled: National Trends in Programs and Policies

The Center for PAS has assembled a list of links to organizations, resources and information available on the web related to Home and Community-Based PAS.

All Home and Community-Based PAS Links

Recent additions