Dear Kansas Programs,
The very brief answer to your question is: “No, the state of Kansas is not one of the states that offers a PCO program.” However, I have taken the liberty of expanding my answer to your question in order to provide additional information to you and a wider audience of interest.
“PCO” stands for “Personal Care Option” a category of personal assistance service available under the federal Medicaid law. The Personal Care Option (PCO) is a state plan service. This means regular, statutory Medicaid requirements governing eligibility, service provision and expenditures must be adhered to by the state that chooses to provide the PCO (See the brief discussion, below about HCBS Waivers). Just as the name suggests, the PCO is an optional service that each state and territory may choose as opposed to the mandatory services that must be provided by every state and territory. However, once a state decides to include the service in its state plan, then the regular Medicaid rules apply. What does all of this mean?
States can design the PCO benefit and target eligible populations. This can have a profound effect on the type and amount of services an individual can receive and on state expenditures for the program. For example according to an AARP study in 20051:
- Per Capita Costs
Per person expenditures for PCO services vary widely from more than $10,000 to less than $1,500.
- Eligibility Criteria
Most states use a functional eligibility standard based on need for assistance with activities of daily living (ADLs). ADLs are commonly defined as toileting, bathing and grooming, dressing, transferring and eating. Catheterization has recently been added to this list in some instances.
Almost 80% of states have set their PCO functional eligibility criteria to be less restrictive than their nursing facility criteria.
- Homebound Restriction
Some states require that services can only be utilized in an individual’s home. People are not allowed to use their services at work or if visiting a friend or family member, for example. It appears that this so called “homebound” type of rule may be required in fewer and fewer states over time. Many States are allowing the services to be provided at home and also at work, during visits or trips outside the home and in other community settings of the person’s choice.
- Types of Services Provided
The services provided mainly cover the functional needs identified by the eligibility process. Thus, assistance with bathing, dressing, toileting, grooming, transferring or positioning and eating is commonly provided under the PCO. Additionally, assistance with laundry, getting around, shopping, housekeeping and meal preparation are also common. Assistance with medication is also a fairly common service. Typically this involves helping people to remember to take medication properly and not actually administering the medication.
- Service Restrictions
Most PCO programs have limitations on the number of hours of services that can be used. These restrictions may be annual, monthly or weekly. Programs may allow so many hours per person annually, monthly or weekly keeping in mind that the programs are usually intended to serve those who are not as functionally impaired as those who qualify for nursing facilities and, therefore HCBS Waivers.
- Individual Control over Services
Over time, more and more states are recognizing the importance of the individual having input and control over their services. This is known as “consumer control”. The majority of programs now allow for consumer control within their PCO programs.
Even though States have control over who is eligible and the types and amounts of services to be provided, state plan services like the PCO must be provided comparably, statewide. This is called the “state wideness” and “comparability” rule. This rule requires the services to be available everywhere, in all geographic areas of a state or territory regardless of population density, ruralness, numbers of providers and so on. Additionally, the service must be the same, provided equally for all eligible people regardless of age, type of disability and so on. The amount, duration and scope of services must be provided equally for all people. There can be no waiting lists, freezes, limitations and so on of services once they are part of the state plan.
Historically, these rules have caused states to be cautious in adopting and utilizing the PCO, especially to be used as comprehensive programs; programs designed to be alternatives to institutions and to meet extensive needs. PCO programs have tended to be small and limited because states are concerned about losing control of their budgets. This explains, in part, why states have chosen to utilize the HCBS Waivers for comprehensive services packages that are designed to offset institutional services. The Waivers, “waive” or allow to be ignored the regular Medicaid rules such as state wideness, comparability, amount duration and scope. This is why Waivers typically have waiting lists, are “frozen” and have caps on numbers to be served.
Kansas has not chosen the PCO due to budgetary concerns outlined, above. Instead, it has chosen to rely on various HCBS Waivers to serve people otherwise eligible for institutions. Kansas has used a state-funded-only program for elderly people only called the Senior Care Act. The Senior Care Act serves elderly people by providing chore and homemaker type services typically found in PCO programs. A big difference is much more generous financial eligibility criteria that allow for sliding scale co-pays. The program has grown significantly over time.
Kansas does have a state plan personal assistance services program; it just isn’t a PCO program. It is called “Working Healthy”. Working Healthy provides services under the aegis of the new Deficit Reduction Act (DRA). The DRA is a new state plan service. However, unlike traditional state plan services that must otherwise meet all the regular Medicaid rules (see above), the DRA acts like a Waiver in that state wideness, comparability, amount duration and scope can be ignored by the state if the state so chooses. The DRA also allows for caps on numbers served and waiting lists. These features help reduce the budget concerns states might have around the traditional state plan PCO service.
Yours truly,
Mike Oxford
1 Kassner, Enid; AARP Public Policy Institute, August 2005.
