Dear Curious,
Currently, 32 states have the "Personal Care Option" (PCO) Medicaid state plan service. Of this 32, two of the states aren't currently serving anyone with their PCO. Additionally, 47 states offer what are called HCBS Waiver services. (Thanks to Terence Ng of the Center for Personal Assistance Services for this information).
The PCO services vary widely in numbers and populations served and generally are more limited in scope and amount of services provided when compared to the HCBS Waivers. The PCO services generally serve more people than the Waivers, however. The HCBS services are, by federal statute, required to offset or be an alternative to an institution such as a nursing facility or intermediate care facility. Generally, they offer a richer package of services that are broader in scope and amount than the PCO and the eligibility thresholds are higher or stricter than the PCO. Examples include personal attendant, home modifications, chore and homemaker, skilled nursing and care management. The PCO is not required to offset an institution and so, generally, the eligibility threshold is lower (less strict). Both the PCO and the HCBS Waivers serve specific, defined populations, but the HCBS Waivers are required to set numerical caps on numbers to serve while the PCO, as a regular state plan service, is not allowed to set numerical caps on numbers to serve, but rather must serve all eligible individuals within the defined service population.
Yet another type of Medicaid "waiver" is called the "1115 Demonstration" Waiver. These are few in number and their purpose is to model or test new types of programs or delivery systems.
The Center for PAS website, under its state information page provides detail on the number of people served and expenditures for Medicaid state plan PCO (under "Federal HCBS Funding to State") and Medicaid Waivers (under "Medicaid Waiver Data in State"). I encourage you to check it out.
Besides the federal, Medicaid personal assistance services, many states have state funded only programs that vary widely (under "State Only Funded HCBS by State"). I would recommend going to the state contacts section of our site ("Contact Info and Descriptions for all State Medicaid Waivers") and asking the state officials if there are state or local programs in their states.
Yours truly,
Mike Oxford
