Home & Community-Based Services: State-Only Funded Programs in U.S

States may be required to contribute match funding to some federally funded long-term care (LTC) programs and to different extents. In FY 2003 states spent 21.4% of total state expenditure on Medicaid (NASBO, 2004). Total expenditures for HCBS are increasing and totaled $16.4 billion in FY 2001, with states paying between 1.7% and 13.3% of total health care expenditures on HCBS in FY 2001 (Milbank 2003). Medicaid spending grew quickly in the early 2000s, forcing state legislatures and officials to investigate ways to contain Medicaid costs rather than expanding services (Coleman et al 2003).

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State	Program name	Administrative Agency	Population served	Annual expenditure ($/yr)^a	Funding source ^b	No. people served^c	Services provided	Eligibility criteria	Further information
AL	State of Alabama Independent Living Services (SAIL.)¹,²,⁴³	Dept of Rehabilitation Services	Physically disabled younger adults (with TBI/SCI)	$8,793,152 FY02	State funds + Federal funds (small grants).	1,660 FY02	AT, attendant care, counseling, education/training, info/referral, medical supplies, modification/repair, prescription drugs, skilled nursing.	Adults 18+ with financial need qualify for the Homebound program. People aged 18+ & who demonstrate that services will improve their independence qualify for Independent Living Support Services, for which there is no income limit.	Cost control: Individual budget $1500/person. Limited state appropriations. Other information This program supplements waivers (e.g. Homebound waiver) & has to free someone for employment, they do not have to go to work & some beneficiaries are employed. Consumer direction Can be consumer directed & relatives can be paid.
AK	Respite³,⁴,⁵,⁴⁴	Dept of Health & Social Services, Commission on Aging	Elderly 60+ with physical disabilities or mental illness, adults with Alzheimer's or related disorders	$489,151 FY02	Mental Health Trust Funds, clients contribute	289 FY05	Chore, homemaker, personal care, respite care.	Caregiver, no functional status requirement. No income or asset limits.	Cost control: Limit of 40 hours/month respite. Co-pay on sliding fee scale. Other information Statewide. Family members can be paid to provide care. Funds allocated to AAAs through a competitive grant program every 3 years
AK	Adult Day⁴,⁵,⁴⁴	Dept of Health & Social Services, Commission on Aging	60+ with physical disabilities, Alzheimer's or related disorders	$951,410 FY02	Mental Health Trust Funds & clients contribute	482 FY05	Adult day care, education/support for caregivers, respite. Therapeutic activity programs at least 5 hrs/day, 3 days/wk	No income or asset limits.	Cost control Co-pay on sliding fee scale. Other information Funds allocated to AAAs through a competitive grant program every 3 years. Funded in 11 communities.
AK	Care Coordination ⁴,⁵,⁴⁴	Dept of Health & Social Services, Commission on Aging	60+ with physical disabilities, Alzheimer's or related disorders	$962,900 FY02 Appropriation	Mental Health Trust Funds, clients contribute	1,195 FY05	Case management	No income or asset limits.	Cost control Co-pay on sliding fee scale. Other information Funds allocated to AAAs through a competitive grant program every 3 years
AR	State Aging Services⁴	N/A	Elderly 60+	$4,686,551 FY02 Appropriation	General Revenue	N/A	Adult day care, case management, chore, homemaker, meals, personal care, respite, transport	Individuals who do not meet the financial & functional eligibility requirements of Medicaid & individuals waiting placement on the Medicaid HCBS program. Income limit, FY02 $1,090/mth (200% FPL). No asset limit.	Cost control: Service limits applied. No cost caps.
AR	Cigarette Tax⁴	N/A	Elderly 60+	$3,000,000 FY02 Appropriation	Tobacco Tax	N/A	Adult day care. chore, case management, homemaker, meals, personal care, respite, transport	Individuals who do not meet the financial & functional eligibility requirements of Medicaid & individuals waiting placement on the Medicaid HCBS program. Income limit FY02 $1,090/mth (200% FPL). No asset limit.	Cost control: Service limits applied. No cost caps.
AZ	State-funded program⁶	Dept of Economic Security, Division of Developmental Disabilities	MR/DD	N/A	General revenue	7,338	All covered on managed care under ALTCS.	People with DD who are not eligible for ALTCS	Consumer direction Can be consumer directed, with fiscal intermediary & capitated payment.
AZ	Arizona Non-Medical Home and Community Based Services³,⁴,⁶	Dept of Economic Security, SUA - Aging & Adult Administration	Elderly 60+ & physically disabled adults	N/A	General Revenue + Federal funds (OAA, Title III-B, Title XX)	15,658 FY03 (may include federally funded clients)	adult day care, case management, chore, emergency response, HH, homemaker, meals, personal care, respite, skilled nursing.	No income or asset limit. Individuals who do not meet the ALTCS financial & medical eligibility requirements & need help with 2 ADLs/2 IADLs	Cost control No service limits. Quality control: contact with case managers, client satisfaction surveys every 2 years. Other information An additional 756 unduplicated clients received payment for homemaker under the Supplemental Payment Program
AZ	Tobacco Tax Program⁴,⁶	Aging & Adult Administration	Elderly	$489,407 FY03	Tobacco Tax & local funds	798 FY02	Aids/devices (main service provided), case management, emergency attendant care, modification/repairs, homemaker, respite, transport,	Individuals who do not meet the financial & functional eligibility requirements of Medicaid. Income limit FY02 $2,214/mth (300% FPL). No asset limit.	Cost control: Adaptive aids or devices, limit of $1000/yr. Modification/repair limit $1,500/yr or per client/home. Co-pay on sliding scale. Quality control: contact with case managers.
CA	Linkages⁴,⁷,⁴⁵	Dept of Aging	Elderly & physically disabled adults (18+)	$8,458,387 FY05-06	General Revenue	5,048 FY05-06	Adult day care, case management, homemaker, meals, medical equipment, modifications/repairs, personal care, transport.	People who need assistance with ADLs. No asset limit.	Other information This program aims to fill gap for individuals not eligible for other care management programs. There was a state-funded in-home support service for seniors & adults with disabilities (In-Home Support Service Residual Program), this is now funded by a Medicaid HCBS waiver..
CA	Adult Day Health Care Program³,⁷,⁴⁵	Dept of Aging	Adults (18+)	$408,688,000 FY05-06	General Revenue, Clients contribute + Federal Funds (Foundation, Title XIX (Medicaid).	47,500 FY05-06 (may include federally funded clients)	Respite	N/A	Other information Statewide. No consumer direction
CA	Alzheimer's Day Care Resource Center³,⁴,⁷,⁴⁵	Dept of Aging	Adults (18+) with Alzheimer's or related disorder	$4,181,200 FY05-06	General revenue, local/county funds	2,627 FY05-06	Counseling, education/training, info/assistance, respite, support groups	Diagnosis of dementia or related disorder. No income or asset limits.	Other information Statewide. No consumer direction
CA	Caregiver Respite Center³,⁷	Dept of Mental Health	Adults (18+)	$11,747,000 FY03	General Revenue, Clients contribute + Federal Funds (OAA TitleIIIE)	14,475 FY02 (may include federally funded clients)	Care management, Counseling, education/training, info/assistance, legal/financial consultation, respite, support groups, transport.	Adult onset cognitive disorder	Cost control Respite cap of $3600/year. Other information Statewide. Can be consumer directed, including payment to family members.
CO	Home Care Allowance ⁸,⁴⁶	N/A	Elderly, Physically disabled	$9,967297 FY 05-06	95% state, 5% counties	3,428 FY 05-06	Direct payments for in-home service provision.	N/A	Cost control Maximum benefit $403/mth, average is $227/mth. Consumer direction Can be consumer directed. Other information A third of participants are also waiver recipients, others not eligible for Medicaid due to income.
CO	Adult Foster Care Program⁸,⁴⁶	N/A	Physically or mentally disabled adults 18+	$82,029 FY 05-06	N/A	23, FY 05-06	N/A	Functional eligibility needs requiring 24 hour non-medical supervision
CO	Older Coloradoans Fund⁴,⁸,⁴⁹	Dept of Human Services	Elderly 60+	$16,400,000 FY05-06 Appropriation	General Revenue + Federal funds (OAA, Title III)	308,246 FY05-06	Adult day care, chore, HH, homemaker, meals, medical equipment, modifications/repair, personal care, respite, transport.	Individuals who are financially &/or functionally ineligible for Medicaid, individuals waiting Medicaid HCBS placement or nursing home placement, individuals receiving Medicaid HCBS. No income or asset limit.	Cost Control: No service limits applied. Quality control: client satisfaction surveys.
CO	State Funding for Senior Services⁴,⁸	N/A	Elderly 60+	$740,000 FY02 Appropriation	General Revenue	N/A	Adult day care, chore, HH, homemaker, meals, medical equipment, modification/repair, personal care, respite, transport	Individuals who are financially &/or functionally ineligible for Medicaid, individuals waiting Medicaid HCBS placement or nursing home placement, individuals receiving Medicaid HCBS. No income or asset limit.	Cost control: No service limits applied. Quality control: client satisfaction surveys.
CT	CT Home Care Program for Elders (category 1&2)⁴,⁹	Dept of Social Services	Elderly 65+, physically disabled adults	$23,000,000 FY02 Appropriation (may include federal funds)	General Revenue + Federal funds (SSBG)	3,439 (FY02) (may include federally funded clients)	Adult day care, case management, chore, companion, emergency response, HH, homemaker, modifications/repair, meals, medical equipment, personal care, respite, skilled nursing, transport.	Program split in 3 categories, category 1&2 services are state-funded with less restrictive financial & functional eligibility criteria than category 3 waiver services. No income limit, asset limit FY02 $18,132 (individual). Functional eligibility criteria: (category 1) 1/2 critical needs & at risk of institutionalization, (category 2) 3/more critical needs but ineligible for Medicaid.	Cost control: Cost cap - Max. $1033/mth, 25% av. Medicaid cost in nursing facility (category 1) $2067 50% av. Medicaid nursing care cost (category 2). Co-pay may be required. No service limits applied. Quality control: annual client satisfaction surveys. Consumer direction Can be consumer directed.
CT	Statewide Respite Care Program³,⁹	Dept of Social Services	N/A	$1,064,181	General revenue, Clients contribute	N/A	Education/training, info/assistance, respite, support groups.	Income limit $30,000/yr, liquid assets less than $80,000. Diagnosis of dementia or related disorder, The individual receiving care cannot be covered by Medicaid.	Cost control Respite cap of $3500/year.
CT	Personal Care State-Funded Pilot Program³,⁹	Dept of Social Services	Elderly 65+	N/A	General revenue	Up to 100 04-06	Chore, counseling, emergency response, family meetings, homemaker, modification/repairs, personal care, respite	Must meet eligibility requirement of Home Care Program to qualify.	Cost control Respite cap of $4067/month. Other information To provide personal care as an alternative to HH aide, families can be paid to provide personal care, homemaker/chore
CT	Alzheimer's Respite⁹	Dept of Social Services	Adults with dementia or related disorders	$1,120,200 FY02 Appropriation	General revenue, clients contribute	491 FY02	Respite, including; adult day care, HH, homemaker, short-term nursing home placement, skilled nursing.	Income limit $2,500/mth, asset limit $80,000/yr (individual).	Cost control: Co-pay 20% of service cost. Cost cap max. $3,500/family/yr Other information: There may be a 'Day Care for Alzheimer's victims' program, for which $180,000 was appropriated in FY02 & served approx 100 individuals.
DC	Senior Services Network⁴	N/A	Elderly 60+	$14,727,000 FY02 Appropriation	General Revenue	N/A	Adult day care, case management, chore, HH, homemaker, meals, medical equipment, modification/repair, personal care, respite, transport.	Individuals who do not meet financial &/or functional eligibility of Medicaid, &/or are waiting for Medicaid HCBS placement. No income or asset limit.	Cost control: No cost caps. Service limits applied. Hours - homemaker 8hrs/wk (this may change according to financial situation in locality).
DE	Community Living Respite¹⁰	Health & Social Services, Division of Services for Aging & Adults with Physical Disabilities	Physically disabled adults (18-59years)	N/A	General revenue	N/A	Personal care, transport, chore & community activities providing personal, social &/or educational enrichment.	Adult residents of Sussex County with physical disabilities age 18-59 living independently but requiring the assistance of a full-time caregiver.	Other information Limited to Sussex County.
DE	Attendant Services¹⁰	Health & Social Services, Division of Services for Aging & Adults with Physical Disabilities	Physically disabled adults (18+)	Up to $680,000/yr	General revenue + federal funds	N/A	Personal care, transport.	Adults (18+) with specific social, financial & physical criteria.	Other information This program was authorized by the state's Medicaid Community Attendant Supports and Services Act (MiCASSA)
DE	Assistive Devices¹⁰	Health & Social Services, Division of Services for Aging & Adults with Physical Disabilities	Physically disabled adults.	N/A	General revenue	N/A	Buy or rent new or used assistive devices	Devices must directly promote independent action/communication, adults must have an assessed need & money is provided only when no other funds are available.	Cost control per purchase cap ($10,000). Lifetime cap $25,000.
DE	Alzheimer's Respite¹⁰	Health & Social Services, Division of Services for Aging & Adults with Physical Disabilities	Adults (45+) with Alzheimer's Disease	N/A	General revenue	N/A	In-home care when the primary caregiver is not there.	Adults (45+) with Alzheimer's Disease	Cost control length of care not to exceed 8hrs/visit.
DE	Home Modification¹⁰	Health & Social Services, Division of Services for Aging & Adults with Physical Disabilities	Physically disabled adults 18+	N/A	General revenue	N/A	Modifications	Adults (18+) with a permanent or long-term disability when no other funding source is available.	Cost control $10,000 lifetime cap.
DE	Emergency Response System⁴,¹⁰	Health & Social Services, Division of Services for Aging & Adults with Physical Disabilities	Elderly & Physically disabled	$49,288 FY02 Appropriation	General revenue	120 FY02	Emergency response system.	At-risk elderly or adults with physical disability who live alone or who are alone a large portion of the day. No income or asset limit
DE	Statewide Respite Services⁴,¹⁰	Health & Social Services, Division of Services for Aging & Adults with Physical Disabilities	Elderly	$124,557 FY02 Appropriation	General revenue, clients contribute	67 FY02	Homemaker, personal care, training/education	No income or asset limit.	Cost control Co-pay on sliding scale
DE	Alzheimer's Adult Day Services⁴	Health & Social Services, Division of Services for Aging & Adults with Physical Disabilities	Adults with dementia or related disorders	$452,220 FY02 Appropriation	General revenue	37 FY02	Caregiver support, day care, meals, respite, transport.	No income or asset limit.
FL	Community Care for the Elderly4,¹¹	Dept of Elder Affairs	Elderly 60+	$42,364,370 FY02-03 (may include federally funds)	80% general revenue, 20% tobacco settlement funds (FY00)	34,476 FY02-03 (may include federally funded clients)	Adult day care, AT, case management, chore, counseling, consumer supplies, education/training, emergency response, homemaker, info & assistance, legal &/or financial consultation, meals, medical equipment, modification/repairs, personal care, respite, support groups, transport.	Individuals who are financially &/or functionally ineligible for Medicaid, individuals waiting Medicaid HCBS placement or nursing home placement, individuals receiving Medicaid HCBS. No income or asset limit.	Cost control: No cost caps. Waiting list. Co-pay on sliding scale (3% of program costs in FY98) some clients exempt (e.g. if they receive waiver services). 10% match required from service providers. Quality control: contacts with case managers, client satisfaction surveys. Other information A Community Care Programs for the Elderly program was funded by General Revenue in FY02-03 ($5.9 million) but it is not funded in FY03-04.
FL	Homecare for the Elderly³,⁴,¹²	Dept of Elder Affairs	Elderly 60+	$9,529,461 FY02-03	General revenue	5,599 FY02-03	Adult day care, AT, case management, chore, counseling, consumer supplies, education/training, emergency response, homemaker, info & assistance, legal &/or financial consultation, meals, medical equipment, modification/repairs, personal care, respite, support groups, transport.	Individuals who are financially &/or functionally ineligible for Medicaid, individuals waiting Medicaid HCBS placement or nursing home placement, individuals receiving Medicaid HCBS. Income limit FY02 $1,635 (300%SSI), asset limit FY02 $2,000 (individual)	Cost control: No cost caps. No service limits applied. A subsidy payment for caregivers to help them maintain low-income elders in their own home. Subsidy intended to fund food, housing, clothing, medical care. There is a specialized subsidy for health care. Quality control: contacts with case managers, client satisfaction surveys. Consumer direction Can be consumer directed.
FL	Alzheimer's Disease Initiative³,⁴,¹²	Dept of Elder Affairs	Caregivers of adults 18+ with dementia or related disorder	$11,394,025 FY03	General revenue, tobacco settlement funds	8,880 FY02	Adult day care, AT, case management, chore, counseling, consumer supplies, education/training, emergency response, homemaker, info & assistance, legal &/or financial consultation, meals, medical equipment, modification/repairs, personal care, respite, support groups, transport.	Diagnosis of dementia or related disorder. Individuals who are financially &/or functionally ineligible for Medicaid, individuals waiting Medicaid HCBS placement or nursing home placement, individuals receiving Medicaid HCBS. No income or asset limit	Cost control: No cost caps. No service limits applied. Co-pay on sliding fee scale (although some clients are exempt, e.g. if they are waiver clients). Quality control: contacts with case manager, client satisfaction surveys. Other information Statewide.
FL	Contracted Services¹¹,¹²	Dept of Elder Affairs	Elderly 60+	$648,424 FY02-03	General Revenue	937 FY02-03	Adult day care, chore, homemaker services, meals, recreation, transport.	N/A	Cost control: no co-pay required. Other information 3 counties only.
FL	Respite for Elders Living In Everyday Families (RELIEF)³	Dept of Elder Affairs	Elderly 60+ & adults with dementia or related disorders	$1,294,530 FY02-03	General revenue	369 02-03	AT, chore, consumer supplies, counseling, education & training, emergency response, homemaker, info/assistance, legal/financial consultation, modification/repairs, personal care, respite, support groups	Homebound people when traditional assistance not available.	Cost control limit of 4hrs/wk respite Other information Multi-county.
GA	Community-based Services Program⁴	Dept of Human Resources, Division on Aging	Elderly 60+	$11,298,871 FY02 Appropriation	General Revenue	13788 FY02	adult day care, homemaker, meals, personal care, respite, transport	Individuals who are financially &/or functionally ineligible for Medicaid, individuals waiting Medicaid HCBS placement or nursing home placement, individuals receiving Medicaid HCBS. No income or asset limit.	Cost control: No cost caps. No service limits applied. Co-pay required on sliding fee scale (individuals with income at/below $922,50/mth - 125% FPL do not pay, those with income over $2,214/mth - 300% FPL pay 100% of service cost). Quality control: outcome measures beginning to be implemented.
GA	State funded Alzheimer's Program⁴	Dept of Human Resources, Division on Aging	Elderly 60+ & adults with dementia or related disorders	$2,873,690 FY02 Appropriation	General Revenue	732 FY02	adult day care, homemaker, personal care, respite	Individuals who are financially &/or functionally ineligible for Medicaid, individuals waiting Medicaid HCBS placement or nursing home placement, individuals receiving Medicaid HCBS. No income or asset limit.	Cost control: No cost caps. No service limits applied. Co-pay required on sliding fee scale (individuals with income at/below $922,50/mth - 125% FPL do not pay, those with income over $2,214/mth - 300% FPL pay 100% of service cost). Quality control: outcome measures beginning to be implemented.
GA	Income Tax Check-Off Fund⁴	Dept of Human Resources, Division on Aging	Elderly 60+	$114,307 FY02 Appropriation	Dedicated income taxes	673 FY02	Meals, transport	Individuals who are financially &/or functionally ineligible for Medicaid, individuals waiting Medicaid HCBS placement or nursing home placement, individuals receiving Medicaid HCBS. No income or asset limit.	Cost control: No cost caps. No service limits applied. Quality control: outcome measures beginning to be implemented.
HI	Kupuna Care³,⁴,⁴⁷	Executive Office on Aging	Elderly 60+	$4,854,305 FY02 Appropriation	General Revenue	6,333 FY05	Adult day care, case management, chore, HH, homemaker, meals, personal care, respite, transport.	Ability of caregiver to provide care. Individuals who are financially &/or functionally ineligible for Medicaid, individuals waiting Medicaid HCBS or nursing home placement. No income or asset limit.	Cost control: cost cap $1000/mth. No service limits. Co-pay required on sliding scale except for case management & meals. Individuals with income at/below $1,107.mth (150% FPL) are not charged. Those with incomes between $1,108-1,845/mth pay 1/3 of service cost, those with incomes between $1,845-2,583/mth (250-350%FPL) pay 2/3 of service cost, individuals with incomes above 350% FPL pay the full cost. Out of pocket health care expenses are deductible. Quality control: program monitoring by AAA staff, client satisfaction surveys, caregiver surveys.
IA	Senior Living Program⁴,¹³	Dept of Elder Affairs.	Elderly 60+	$4,177,291 FY02 Appropriation	Trust Fund	9,548 FY02	Adult day care, case management, chore, emergency response, HH, homemaker, meals, medical equipment, modifications/repair, personal care, respite, skilled nursing.	Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid &/or individuals waiting placement on the Medicaid HCBS program or individuals receiving Medicaid HCBS. Income limit FY02 $2,148/mth (between 300% SSI & 300% FPL). No asset limit.	Cost control: No cost caps. No service limits applied. Consumer direction Can be consumer directed. Other information Tobacco settlement monies have also been used to expand respite services options in the state40
IA	Elderly Service⁴	Dept of Elder Affairs.	Elderly 60+	$3,123,757 FY02 Appropriation	General Revenue	10,407 FY02	Adult day care, case management, chore, emergency response, HH, homemaker, meals, medical equipment, modifications/repair, personal care, respite, skilled nursing.	Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid &/or individuals waiting placement on the Medicaid HCBS program or individuals receiving Medicaid HCBS. No income or asset limit.	Cost control: No cost caps. No service limits applied. Quality control: review every 4 years. Consumer direction Can be consumer directed.
ID	Family Support & In-home Assistance¹	Dept of health & Welfare, Div. of Family & Community Services	Children & adults with developmental disabilities	N/A	N/A	901 FY03	Counseling, HH, meals, medical & dental care, modifications, PAS, respite, special equipment, therapies, transport.	Funds can only be used after all other funding sources are used. Aimed at families of individuals at risk of institutionalization or who are transitioning out of institutions.	Cost control - individual budget $250/mth per family Consumer direction Can be consumer-directed.
ID	Senior Services Act Respite Program³,⁴	Commission on Aging	Elderly 60+	$864,020 FY02 Appropriation	General Revenue	2,555 FY02	adult day care, case management, chore, education/training, emergency response, family consultation/meetings, homemaker, info/assistance, meals, medical equipment, modifications/repair, personal care, respite, transport.	Needs help with 1 ADL. Caregiver must be 60+. Individuals who are financially &/or functionally ineligible for Medicaid, individuals waiting Medicaid HCBS or nursing home placement. No income or asset limit.	Cost control: No cost caps. No service limits applied. Co-pay required on sliding fee scale for homemaker & chore services for those with income over $738/mth (FPL) Quality control: client satisfaction surveys. Consumer direction Can be consumer directed. Other information Statewide.
IL	Community Care Program²⁷,⁴	Dept of Aging	Elderly 60+	$263,030,700 FY04	General Revenue	N/A	Adult Day care, case management, homemaker, transport.	People who do not qualify for Medicaid waiver-funded part of the Community Care program. Asset level limit $10,000 (individual). Individuals can be in receipt of Medicaid HCBS services. No income limit.	Cost control: cost caps which vary by assessment score & service type. No service limits applied. Co-pay required on sliding fee scale. Quality control: Service Improvement program, including reviews of services, client and staff satisfaction surveys. Other information Supplements waiver program.
IL	Home Delivered Meals⁴	Dept of Aging	60+, housebound, frail, disabled, isolated	$6,600,000 FY02 Appropriation	General revenue	21,539 FY02	Meals.	No income or asset limit.
IN	Community & Home Options to Institutional Care for the Elderly (CHOICE)¹,³,⁴,¹⁵,⁴⁸	Family & Social Services Administration (FSSA)	Elderly 65+, physically disabled adults	$32,539,954 FY 06 (may include Federal funds)	General revenue + Federal funds	3,418 FY06 (may include Federally funded clients)	Adult day care, AT, case management, chore, emergency response, HH, homemaker, legal/financial consultation, meals, medical equipment, modifications/repair, personal care, respite, transport & "other necessary services" to help people stay at home (e.g. pest extermination).	Unable to perform 2 ADLs. Individuals who do not meet the financial & functional eligibility requirements of Medicaid & individuals waiting placement on the Medicaid HCBS program, &/or individuals receiving Medicaid HCBS services. No income or asset limit	Cost control: cost cap $2,286/mth. Service limits applied. Waiting list - 5,561 (FY99) wait time up to 22 mths. Co-pay on sliding fee scale (individuals with income at/below $1107/mth, 150% FPL pay nothing, individuals with incomes at/above $2584/mth, 351% FPL, pay full cost of services). Quality control: case manager contact clients every 90 days, client satisfaction survey, annual state review. Consumer direction Some pilot consumer directed programs. Other information 25% of waiver participants are also CHOICE beneficiaries. Intended as a program for older people, 20% of CHOICE funds are spent on younger beneficiaries. AAAs are a single entry point.
KS	Senior Care Act Program ³,⁴,¹⁶	Dept of Aging	Elderly 60+	$7,424,665 FY05 (with copay from consumers and local match)	General Revenue, local funds, clients contribute	6,500 FY05	Adult day care, AT, chore, case management, continence supplies, emergency response, homemaker, HH, material assistance, meals, medication, mobility aids, modifications, personal care, respite, transport.	2 ADLs, 3+ IADLs or combination of ADL/IADLs. Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid &/or individuals waiting placement on Medicaid HCBS program or placement in a nursing home. No income or asset limit.	Cost control: Cost cap $1,445/mth. $1332 av. Individual expenditure/yr. No service limits applied. Co-pay on sliding scale related to liquid assets. Quality control: Quality Assurance Division reviews individual care. Consumer direction Can be consumer directed.
KS	Income Eligible Program¹⁶	Dept on Aging	Elderly, 60+	$4,322,172 FY00	General revenue	3,147 FY00	In addition to in-home services, the program has flexibility to meet individual needs on a case-by-case basis	People with incomes less than 150% FPL who are not Medicaid eligible because of their income level &/or assets, but are at risk of institutionalization because of their functional level & would be able to reside in a community based residence if some services were provided.
KS	In-Home Nutrition Program¹⁶	Dept on Aging	Elderly	$1,069,411 FY00	General revenue	N/A	Meals	Individuals who are moderately to severely impaired, and who are homebound
KS	State-Funded Case Management¹⁶	Dept on Aging	Elderly (60+)	$2,820,456 FY05	General revenue	3,313 FY05	Case management.
KS	State-Funded Custom Care¹⁶	Dept on Aging	Elderly	$94,846 FY00	General revenue	668 FY00	Services to meet individually assessed needs, e.g. bath benches, food supplements & incontinence supplies.
KS	State Funded Environmental Modification¹⁶	Dept on Aging	Elderly	$64,919 FY00	General revenue	336 FY00	Modification/repair
KY	Supported Living Program (1992)¹⁷	Mental Health/Mental Retardation Boards.	Adults with ADA defined disabilities.	N/A	N/A	549 FY01	Flexible, one-time supports & services, modification/repairs.	Individuals determine own needs, manage their own plans & hire providers.	Other information Clients apply direct to regional Mental Health/Mental Retardation Regional Board for program.
KY	Homecare Program⁴,¹⁷	Cabinet for Health Services, Division of Aging Services	Elderly 60+	$15,301,500 FY02 Appropriation	General Revenue	11,700 FY03	Case management, chore, HH, homemaker, meals, personal care, respite, transport.	Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid &/or individuals waiting placement on the Medicaid HCBS program or placement in a nursing home or individuals receiving Medicaid HCBS. Income limit FY02 $1,388/mth (based on FPL). No asset limit.	Cost control: No cost caps. Service limits applied: $500/year repairs. Co-pay - 80% of cost of service. Quality control: case manager contacts monthly.
KY	Personal Care Attendant Program¹⁷	Cabinet for Health Services, Division of Aging Services	Adults with severe physical disability	N/A	General Revenue	N/A	Homemaker, chore, meals, personal care, transport.	Individuals at risk of nursing home placement. Need at least 14hrs/wk -40hrs/wk care.	Financial subsidy to clients to hire & supervise personal care attendants. Consumer direction Can be consumer directed.
KY	Adult Day Care & Alzheimer's Respite Program³,⁴,¹⁷	Dept of Medicaid Services	Adults with Alzheimer's Disease or dementia.	$2,773,800 FY02 Appropriation	General revenue, clients contribute	3,250 (FY02)	AT, care management, chore, education/training, homemaker, info/assistance, modifications, personal care, respite, transport.	2 ADLs, 3+ ADLs, diagnosis of dementia or related disorder. No income or asset limit.	Cost control Co-pay on a sliding scale Other information Supportive & Therapeutic program providing supervision & care to beneficiaries for part of a 24 hour period.
LA	Nutrition/meals ⁴	N/A	Elderly 60+	$5,100,000 FY02 Appropriation	General revenue	N/A	Meals.	No income or asset limit
LA	Transportation⁴	N/A	Elderly 60+	$600,000 FY02 Appropriation	General revenue	N/A	Transport.	No income or asset limit
LA	Homemaker⁴	N/A	Elderly 60+	$500,000 FY02 Appropriation	General revenue	N/A	N/A	No income or asset limit
MA	Statewide Head Injury Program¹⁸,¹⁹	Rehab Commission	Anyone with a TBI	$10,300,000 FY02	N/A	770 FY02	Family assistance, respite, therapy, training/education.	N/A	Other information Community supports are available but very limited, due to funding
MA	Home Care Assistance Program¹⁸,¹⁹	Rehab Commission	Adults with physical disabilities (18-59)	$5,616,000 FY02	N/A	1,532 FY02	Homemaker services, not personal care.	Not blind, functional impairment, lives alone or with another disabled person, meets financial guidelines, at risk of institutionalization.	Cost control maximum 12hrs/week. Consumer direction Can be consumer directed.
MA	Home Care Program ³,⁴,¹⁸,¹⁹,²⁰	Office of Elder Affairs	Elderly 60+, adults 18+ with a diagnosis of dementia & in need of respite.	$150,000,000 FY02 appropriation (may include federal funds)	General Revenue, Clients contribute	39,000 (FY02) (may include federally funded clients)	Adult day care, case management, chore, emergency response, HH, homemaker, info/assistance, meals, modifications, personal care, respite, skilled nursing, transport.	Flexible functional & financial eligibility criteria (minimum of 4 ADL &/or IADLs with critical unmet need). Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid &/or individuals waiting placement on the Medicaid HCBS program or placement in a nursing home or individuals receiving Medicaid HCBS. No asset limit. Income limit annual gross income less then $20,779 (individual).	Cost control: No service limits. Capped mthly payment to AAAs. Co-pay - mthly fee based on annual gross income ($7-$135/mth when individual income between $9,139-$20,778/mth). Quality control Peer reviews of assessments & care plans. Worker training. Background checks. Client satisfaction surveys Consumer Direction Can be consumer-directed. Other information Medicaid waiver program is part of the Home Care program but has separate functional eligibility criteria, MassHealth recipients are financially eligible.
MD	Adult Day Care Home Services Grant¹,²¹	Dept of Health & Mental Hygiene	Elderly, Physically disabled adults	$2,778,862 FY99	General revenue, clients contribute	750 FY99	Activity program, counseling, meals, nursing & social work, personal care, transport.	Non-Medicaid eligible adults 55+ with functional limitations at risk of institutionalization. Sliding scale co-pay scheme taking family size & income into account.	Cost control limited state appropriation. Quality control Professional certification requirements, background checks. Consumer direction Can be consumer directed.
MD	Senior Care Program¹,²¹	Dept of Aging	Elderly (65+)	$6,573,000 (FY99)	General revenue	3702 (FY 1999)	AT, case management, chore, day care, emergency response, meals, medication, medical supplies, personal care, respite, transport & other services (glasses, dentures, hearing aids). Includes a small grant program allowing families to hire/fire workers or buy supplies & services.	65+ at risk of entering nursing home. Income cannot exceed 60% median state income (or $1857/month for a single person in 2000), assets cannot exceed $11,000 (one person) & non-eligible for other public or private programs.	Cost control Limited appropriations, 5 counties have income-related co-pay, 6 counties have per person cap on services, 13 counties limit services. Statewide $500/mth cap per person. Av. annual expenditure/slot - $198 (2000). Local waiting lists (3,831 FY99) av. wait - 7 mths. Quality control 6 mthly case manager visit. Consumer direction Consumer direction depends on county. Other information 2 small state & federal funded programs provide similar services in group homes.
MD	Attendant Care Program¹,²¹	Department of Disabilities	Physically disabled adults (18-64years)	N/A	N/A	93 FY01	Chore, personal care, transport.	Applicants must be either; employed, actively seeking employment, wishing to transfer out of a nursing facility or on a nursing facility waiting list. Need help with ADLs, supervision or general help to stay in the community. Means tested.	Other information Beneficiaries receive cash reimbursement of their attendant costs. Attendant care in the workplace, home. Can be consumer directed, including hiring & firing own workers, individual budget up to $8,450/yr
MD	Social Services to Adults¹,²¹	Dept of Human Resources	Physically disabled adults (18+)	N/A	N/A	N/A	Adult foster care, case management, chore, financial assistance, personal care	Need help with ADLs, supervision or general help to stay in the community. Means tested if under 65.	Quality control local Social Services Depts.
MD	Project Home¹,²¹	Dept of Human Resources	Physically disabled adults (18+)	N/A	N/A	1726 FY01	Adult Foster care evaluation, placement & case management	Need help with ADLs, supervision or general help to stay in the community. Means tested.	Cost control 20hrs/week cap. Quality control local Social Services Depts.
MD	In-home Aide Services¹,²¹	Dept of Human Resources	Physically disabled adults (18+)	N/A	N/A	N/A	Case management, chore, financial assistance, personal care.	Need help with ADLs, supervision or general help to stay in the community. Means tested.
MD	Respite for caregivers of adults with functional disability³	Dept of Human Resources	Physically disabled adults (18+)	N/A	General revenue	N/A	Case management, counseling, education/training, emergency response, family consultation/meetings, homemaker, chore, personal care, info/assistance, respite.	3+ ADLs	Cost control Respite cap 164hours/year.
ME	Home Based Care³,⁴,²²	Dept of Human Services (Bureau of Elder & Adult Services)	Elderly (60+) physically disabled adults (18+)	$11,677,222 FY03	General Revenue, Clients contribute	2,359 FY03	Adult day care, chore, case management, emergency response, HH, homemaker, meals, modifications/repair, personal care, respite, skilled nursing, transport.	1 ADL + 2 other ADLs/IADLs or nursing. Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid. No income or asset limit.	Cost control: Cost caps - level I $1000/mth, level II $1250/mth, level III $1,800/mth, level IV $3,436/mth (levels based on functional need). Service limits: $3800/year respite cap. Co-pay - 3% of assets monthly, $15,000 asset disregard, 4% of monthly income. Quality control: case reviews, provider audits, client satisfaction surveys. Consumer direction Can be consumer directed.
ME	Home based Care: Consumer-directed²²	Dept of Human Services (Bureau of Elder & Adult Services)	Elderly (60+) physically disabled adults (18+)	$2,825,710 FY03	General Revenue, Clients contribute	163 FY03	Adult day care, HH, respite.	1 ADL + 2 other ADLs/IADL & ability to self-direct. No income limit, $30,000 asset disregard. Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid
ME	Homemaker Services⁴,²²	Dept of Human Services (Bureau of Elder & Adult Services)	60+	$1,928,270 FY03	General revenue, clients contribute	2,194 FY03	Chore, homemaker, meal.	Need help with housekeeping, laundry groceries. No income limit, assets less than $50,000 (individual).	Cost control Co-pay 20% service cost
ME	Adult Day Services⁴,²²	Dept of Human Services (Bureau of Elder & Adult Services)	60+	$371,193 FY03	General revenue, clients contribute	131 FY03	Adult day care	1 ADL or cueing with 4 ADLs. No income limit, assets less than $50,000 (individual).	Cost control Co-pay 20% service cost
ME	Alzheimer's Respite⁴,²²	Dept of Human Services (Bureau of Elder & Adult Services)	Adults (60+) with dementia	$734,443 FY03	N/A	1,169 FY03	Respite.	Dementia diagnosis. No income limit, assets less than $50,000 (individual).	Cost control Co-pay 20% service cost. Other information Supplements federally funded (AoA) Alzheimer's Project.
MI	PAS Reimbursement for Employment¹,²³	MI Dept of Career Development (MI Rehab Services)	Working, disabled adults	N/A	N/A	50 FY01	Personal assistance in the workplace.	N/A	Cost control Service limits applied: $1000/mth maximum
MI	Physical Disabilities Services Program¹,²³	Dept of Community Health	All adults, subject to funding availability.	$1,300,000 FY99	N/A	N/A	Modifications, AT not reimbursable under Medicaid.	N/A
MI	State/Escheat Respite³	Office of Services to the Aging	Elderly, 60+	$2,442,565 FY03	Blue Cross/ Blue Shield Escheat funds	N/A	Respite.	No functional status requirement.	Other information Statewide.
MI	Caregiver Respite Program³	Office of Services to the Aging	Caregivers of adults 18+ with a medical disability	$4,972,401	Tobacco settlement fund	N/A	Respite, transport.	No functional status requirement if over 60	Other information Statewide.
MI	Personal Care⁴	N/A	60+	$2,664,208 FY02 Appropriation	General revenue	2967 FY02	N/A	No income or asset limit
MI	Homemaker⁴	N/A	60+	$3,305,245 FY02 Appropriation	General revenue	6,275 FY02	N/A	No income or asset limit
MI	Adult Day Care⁴	N/A	elderly (60+), adults with disabilities	$2,135,372 FY02 Appropriation	Revenue from unclaimed property, tobacco settlement & clients contribute	128 FY02	N/A	No income or asset limit
MI	In-Home Respite⁴	N/A	elderly (60+), adults with disabilities	$3,277,041 FY02 Appropriation	Revenue from unclaimed property, tobacco settlement & clients contribute	846 FY02	N/A	No income or asset limit
MI	Care Management⁴	N/A	60+	$7,869,229 FY02 Appropriation	General Revenue	12,509 FY02	N/A	No income or asset limit
MN	Alternative Care³,⁴,²⁴	Dept of Human Services	Elderly 65+	$55,807,000 FY05	General revenue	7,557 FY05	Adult day care, adult foster care, case management, cash grants, chore, education/training, emergency response, habilitation, info/assistance, homemaker, HH, modifications, meals, medical equipment, modification/repairs, personal care, respite, skilled nursing, transport.	Low income & assets, at risk of nursing home placement (nursing home level of care). Individuals who do not meet the financial eligibility requirements of Medicaid. Income & asset limit FY02 - combined income & assets are at/below $22,819 (income & assets would cover 6 mths/less of nursing home costs based on individual's level of need).	Cost control: No cost caps. No service limits applied. Co-pay on sliding fee scale ($1,292/mth - 175% FPL pay 25%of cost of services, excluding case management). Quality control: site visit, random interviews. Consumer direction Can be consumer directed. Other information 2003 - eligibility criteria tightened, expansion of mthly fees which meant some beneficiaries dropped out of the program. This may be part of a larger program with an FY02 appropriation of $65 million.
MN	Non-waiver MA Home Care²⁴	Dept of Human Services	Elderly	$15,83,000 FY05	N/A	3,380 FY05	Homecare	N/A
MN	Senior Nutrition⁴	Dept of Human Services	Elderly (60+)	$2,740,000 FY02 Appropriation	General Revenue	88,000 FY02	N/A	No income or asset limit
MN	Caregiver Support⁴	N/A	Elderly (60+)	$453,000 FY02 Appropriation	General Revenue	7,000 FY02	N/A	No income or asset limit
MO	None found although there may be a program for non-Medicaid eligible people called the Personal Attendant Services Program²⁵
MS	None found
MT	None found
NC	Respite Care Program³	Dept of Health & Human Services, Div. of Aging & Adult Services	Adults 18+ (either caregiver or receiver must be 60+)	$316,102 FY03	General revenue, clients contribute	N/A	Chore, counseling, education/training, homemaker, info/assistance, personal care, respite, support groups.	Physically disabled &/or diagnosis of dementia or related disorder.	Cost control: No cost caps. No service limits applied
NC	Home & community Care Block Grant³	Division of Aging & Adult Services	Elderly 60+	$23,449,112 FY02 Appropriation	General Revenue	72,907 FY02	Adult day care, case management, HH, meals, modifications/repairs, personal care, respite, transport.	Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid &/or individuals waiting placement on the Medicaid HCBS program or placement in a nursing home. No income or asset limit.	Cost control No service limits applied.
ND	Service Payments for the Elderly & disabled (SPED)²⁶	Dept of Human Services	Elderly, physically disabled.	$6,381,000 FY03	95% General revenue, 5 % county funds	2007 FY03	Adult foster care, case management, chore, emergency response, family homecare, homemaker, modifications, PAS, respite.	Assets less than $50,000. Impairments in 4 ADLs/5 IADLs which have lasted/are expected to last at least 3 mths. Under 18s screened for nursing facility level of care, must be ineligible for waivers, living in community & capable of directing own care or have a legally responsible person. People with mental illness & MR/DD not covered.
ND	Expanded SPED²⁶	Dept of Human Services	Elderly, physically disabled adults.	$535,900 FY03	General revenue	233 FY03	Adult foster care, case management, chore, emergency response, family homecare, homemaker, modifications, PAS, respite.	Recipients eligible for Medicaid & SSI, nursing home level of care, able to toilet, transfer, eat independently but impaired in 3 of 4 activities; meal preparation, housework, laundry, or taking medication (health, welfare, or safety needs otherwise requiring care in an institution).
ND	Family Home Care³	Dept of Human Services	Adults (18+)	$779,728 FY03	General revenue	N/A	Cash grants, respite.	3 or more ADLs	Cost control Respite cap $550/month, families can be paid to provide respite care.
NE	Respite Subsidy Program Across the lifespan³,⁴	Dept of Health & Human Services	N/A	$810,000 FY02 Appropriation	General revenue, tobacco settlement funds	415 FY02	Respite	income limit $2,304/mth, asset limit $38,000 (individual).	Cost control Respite cap of $125/month. Other information Family members may be paid to provide services. There may be at least 3 partly state-funded programs (Disabled Persons & Family Support Program, Disabled Children's Program).
NE	Care Management⁴	Health & Human Services	N/A	$1,716,558 FY02 Appropriation	General revenue, clients contribute	8,975 FY02	N/A	No income or asset limit.	Cost control Co-pay on sliding scale
NE	Disabled Persons & Family Support⁴	Health & Human Services	Elderly & physically disabled adults	$910,000 FY02 Appropriation	General Revenue	550 FY02	Adult day care, HH, homemaker, meals, medical equipment, modification/repairs, personal care, transport.	Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid &/or individuals waiting placement on the Medicaid HCBS program or individuals receiving Medicaid HCBS. Income limit FY02 $1,364/mth (185% FPL). No asset limit.	Cost control: Cost cap $300/mth. Service limits applied: hours - $100/mth chore. Quality control: client driven, client selects provider. Consumer direction Can be consumer directed.
NH	Family Supports Services²⁷	Family Support Councils	MR/DD	$4,200,000 FY02	N/A	3000 FY02	AT, information & referral, respite.	Aimed at strengthening support for families not served under the DD waiver & supplement waiver services.	Other information There is consumer involvement in the service development & Area Agencies serve as single points of entry. Amount, duration & scope of services is more limited than the waiver program.
NJ	Statewide Respite Care program (1988)³,⁴,²⁸	Dept of Health & Senior Services, Senior Affairs Division	Caregivers of adults 18+ with physical or mental disabilities.	$5,750,000 FY03	Casino revenue funds, General Revenue, clients contribute	3,060 FY02	Respite: paid & volunteer companions, homemaker, home health aides (hourly, 12 hour or 24 hour). Private duty nursing, medical or social day services.	Aims to delay institutional placement & provide respite for carers. Income limit $1,635/mth (individual) & assets limit $40,000 (individual).	Cost control: expenditure cap $3000 per person. Co-pay on a sliding scale. Other information Services may vary between counties. The waiver program has a much lower asset limit.
NJ	Jersey Assistance for Community Caregiving (JACC)³,⁴,²⁸	Dept of Health & Senior Services, Senior Affairs Division	Elderly (60+)	$10,000,000 FY03	General Revenue	1,873 FY02	Adult day care, caregiver training/education, case management, chore, counseling, emergency response, family consultation/meetings, HH, homemaker, info/assistance, modifications/repair, meals, medical equipment, personal care, respite, transport.	Same eligibility & services as the waiver (nursing home level of care). Aims to provide seamless services for elderly in their own homes who can pay for services initially then require Medicaid waiver support. Income limit FY02 $2,694/mth (365% FPL). Asset limit FY02 $40,000 (individual)	Cost control: cost cap $600/mth, $7200/yr. No service limits. Co-pay on sliding scale based on income (individuals with less than $981,99/mth have no co-pay, individuals with $2,400-$2,695 have a $120 co-pay). Quality control: client satisfaction survey, case management reviews, complaint checks on providers. Consumer direction Can be consumer directed.
NJ	Adult Day Services Program for Persons with Alzheimer's Disease or Related Dementias³,⁴	Dept of Health & Senior Services, Senior Affairs Division	Adults 18+ with Alzheimer's or related disorder	$2,483,000 FY03	Casino revenue, general revenue, clients contribute	884 FY02	Counseling, education/training, info/assistance, respite, support groups.	Diagnosis of dementia & related disorders. Income limit $3,270.mth, asset limit $40,000 (individual).	Cost control Co-pay on a sliding scale
NJ	Home-Delivered Meals⁴	Dept of Health & Senior Services, Senior Affairs Division	N/A	$1,870,832 FY02 Appropriation	Casino Revenue Funds, General Revenue	8,094 FY02	N/A	No income or asset limit.
NJ	Congregate Housing Services Program⁴	Dept of Health & Senior Services, Senior Affairs Division	N/A	$3,093,000 FY02 Appropriation	Casino Revenue Fund, General Revenue	2,994 FY02	HH, homemaker, personal care.	Income limit FY02 $930/mth	Cost control Co-pay based on sliding fee scale.
NM	State General Fund Developmental Disabilities Program²⁹	Dept of Health	Adults with MR/DD (22+)	N/A	General revenue	N/A	Habilitation/vocational services, residential services, respite.	Services only available to people not already on the DD waiver & who do not meet the medical and financial eligibility criteria of the waiver. Participants are required to have limitations in 3 or more ADLs
NM	Multi-Service Group⁴	N/A	Elderly 60+	$10,905,536 FY02 Appropriation	General Revenue	115675 FY02	Adult day care, case management, chore, homemaker, meals, modification/repairs, personal care, respite, transport.	Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid &/or individuals waiting placement on the Medicaid HCBS program or placement in a nursing home or individuals receiving Medicaid HCBS. No income or asset limit.	Cost control: No cost caps. No service limits applied
NM	Indian Area Agency on Aging⁴	Indian Area Agency on Aging	Elderly 60+	$1,665,352 FY02 Appropriation	General Revenue	3900 FY02	Adult day care, case management, chore, homemaker, meals, modifications/repairs, personal care, respite, transport.	No income or asset limit.	Cost control: No cost caps. No service limits applied. Quality control: Indian AAA monitors service providers, providers monitor delivery to clients.
NM	Navajo Area Agency on Aging⁴	Navajo Area Agency on Aging	Elderly 60+	$1,006,642 FY02 Appropriation	General Revenue	4300 FY02	Homemaker, meals, respite, transport.	No income or asset limit.	Cost control: No cost caps. No service limits applied. Quality control: Navajo AAA monitors 3 Navajo agencies, agencies oversee service provision.
NV	In-home Personal Assistance³⁰	Dept of employment, training & Rehab, Office of Community based Services.	Adults with disabilities.	$10,573,000 FY04 projection	N/A	Approx 78/year (141 99-01)	Personal care.	People at risk of institutionalization.	Other information Wait list of 166 people. No new people added to the program in over 5 years.
NV	AT Loan Program³⁰	Dept of employment, training & Rehab, Office of Community based Services.	N/A	$1,400,000 FY02	Nevada State Bank	46 FY02	Clients borrow money to buy devices for independent living. Av. total cost to service of a loan is $1600 ($450 of this is interest paid by the client).	N/A
NV	TTY Distribution Program³⁰	Dept of employment, training & Rehab, Office of Community based Services.	Physically disabled adults & children	$273,000 FY04 projection	Surcharge on phone access lines	88 FY01	AT - free telecommunication devices for people with sensory or speech impairment.	No waiting list.
NV	Independent Living Services³,³⁰	Dept of Human Resources	Care receiver age 60+	$2,377,000 FY04 projection	Tobacco fund	176 FY01	AT, case management, chore, counseling, education/training, homemaker, legal/financial consultation, modification, personal care, respite, transport.	No functional status requirement.
NV	Community Based Care Caregiving Training³	Dept of Human Resources	N/A	$261,183 FY03	General Revenue	241 FY02	Education/training	No functional status requirement.
NY	Community Services for the Elderly³¹	NYC Dept for Aging	Elderly	$5,966,921 FY04 projection	General revenue, local funds	N/A	Adult day care, case management, chore, emergency response, homemaker, legal assistance, meals, personal care, transport.	Frail., low income elderly living at home.
NY	Long Term Home Health Care Program³¹	Sullivan County Social Services Dept	Elderly (60+) one county only	$15,000	Local funds	N/A	Case management, meals, modifications, respite, social day care, transport.	Individuals with a nursing home level of need & choose to receive services in their home. Counties determine eligibility	Cost control: Care costs must be less than the nursing homes cost in the county.
NY	Expanded In-home Services for the Elderly (1987)⁴,³¹	Dept of Health, Office for the Aging	Elderly (60+)	$25,500,030 FY02 Appropriation (may include federal funds)	General revenue, local funds, clients contribute	34,545 FY02 (may include federally funded clients)	adult day care, case management, emergency response, homemaker, medical equipment, modification/repairs, personal care, respite.	Individuals who do not meet the financial eligibility requirements of Medicaid, want to remain at home & need help for ADLs such as dressing. No income or asset limit.	Cost control: No cost caps. No service limits applied. Co-pay on sliding fee scale for individuals with incomes at/above $1107/mth (150% FPL) except for case management or item on loan. . Quality control: Quarterly reports, yearly evaluations & site visits.
NY	Respite Program³	Dept of Health, Office for the Aging	Elderly (60+)	N/A	General revenue, Local/county funds	N/A	AT, case management, chore, consumer supplies, counseling, education/training, emergency response, family consultation/meetings, homemaker, info/assistance, legal/financial assistance, modifications/repairs, personal care, respite, support groups, transport.	N/A	Other information Not statewide.
NY	Supplemental Nutrition Program⁴	Dept of Health, Office for the Aging	Elderly, 60+	$17,209,000 FY02 Appropriation	General Revenue	30,944 FY02	N/A	No income or asset limit
OH	Senior Options³²,¹¹	County Office on Aging	Elderly (60+)	$15,000,000 (approx. annual figure)	County property taxes	4000/mth (approx)	Adult day care, emergency response, homemaker, meals, modification, personal care, respite, transport.	Seniors with difficulties with ADLs. 60% of participants have monthly incomes below $1000 & limited assets. Assets are considered in the cost-sharing calculation.	Cost Control Cost sharing. Other information Operated originally in 2 counties, since 1991 operates only in Franklin County. Services provided by approx. 60 community-based public, non-profit & for-profit providers. Other counties in Ohio have also used levies to develop senior services.
OH	Alzheimer's Respite Program³,⁴	Dept of Aging	N/A	N/A	General Revenue & Clients contribute	N/A	Adult day care, case management, chore, counseling, education/training, emergency response, family consultation/meetings, homemaker, info/assistance, personal care, respite.	Diagnosis of dementia or related disorder. Individuals who do not meet the financial eligibility requirements of Medicaid &/or individuals waiting placement in a nursing home or individuals receiving Medicaid HCBS. No income or asset limit.	Cost control: No cost caps. No service limits. Co-pay on sliding fee scale. Quality control: integrated into AAA monitoring. Consumer direction Can be consumer directed. Other information Family members can be paid.
OH	Senior Community Services Block Grant⁴	Dept of Development	Elderly 60+	N/A	General Revenue	N/A	Adult day care, homemaker, meals, modification/repairs, personal care, respite, transport.	No income or asset limit.	Cost control: No cost caps. No service limits applied. Quality control: Monitoring visits.
OK	Respite Resource Network³	Dept of Human Services	Elderly (60+) dementia or physically disabled	N/A	General revenue + Federal funds (OAA, Title IIIE)	N/A	Respite	2+ ADLS, diagnosis of dementia or related disorder.	Cost control Respite cap $1600/year. Consumer direction Family members can be paid to provide care.
OK	Adult Day Care⁴	Aging Services Division	60+ & physically disabled	$2,997,670 FY02 Appropriation	General Revenue	851 FY02	Adult Day Care	Income limit $739/mth, no asset limit.
OR	Project Independence³³^,4	Dept of Human Services.	Elderly (60+), adults with dementia or related disorder.	$5,579,872 FY02	General revenue & local non-profits	4,400 FY02	Adult day care, case management, chore, HH, homemaker, meals, modification/repairs, personal care, respite, transport.	Low income seniors who have difficulty with basic activities of daily life. Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid. No income or asset limit.	Cost control: No cost caps. No service limits. Co-pay on a sliding fee scale. 2004, no co-pay if income less than $776/mth individual (FPL net mthly income), increments up to 200% FPL, $1,501/more pays the full cost. Max. mthly fees not more than 30% net mthly individual income. Quality control: client satisfaction surveys, site visits & reviews. Consumer direction Can be consumer directed. Other information Allocations made to counties. Av. cost per client $250/mth.
OR	Oregon Spousal Pay Program³³	Dept of Human Services.	Physically disabled, cared for by relatives	$3,066,954 FY02	General revenue	236	Same services as Medicaid waiver but care provided by spouses who cannot receive payment under the waiver.	People who are financially eligible for Medicaid but have exceptionally high levels of need & are cared for by their spouse.
PA	Options Program³,⁴,¹¹,³⁴	Dept of Aging	Elderly & physically disabled adults (18-59)	$206,617,706 FY02 Appropriation	State Lottery, general revenue, clients contribute + Federal funds (OAA Title III-E, Title XX)	229,506 FY02	Adult day care, chore, case management, emergency response, habilitation, HH, homemaker, info/assistance, meals, medical equipment, modifications/repair, personal care, respite, skilled nursing, transport. Counseling & medical equipment/supplies usually paid for by Medicaid/Medicare or another third party.	60+ needing help with 2-6 ADLs. Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid. No financial eligibility requirement. Assessment by AAA who may refer to waiver program. No income or asset limit.	Cost control: Cost cap $625/mth. No service limits. Each AAA has a slot allocation & the aggregate cost of client care cannot exceed 45% of nursing home care costs. Co-pay on sliding scale if income above 125% FPL (2003, $935/individual), income at/above $2214/mth (300% FPL) pay full cost of service. Quality control: data analysis, on-site monitoring. Consumer direction Can be consumer directed. Other information Min. hrly wage $8 for home aides to attract workers, $0.10/hr increase to aides who recruit a friend.
PA	Bridge Program³,¹¹,³⁴	Dept of Aging	Elderly (60+)	N/A	Tobacco settlement funds, Client contributes	N/A	counseling, emergency response, HH, info/assistance, meals, medical equipment, modification, personal care, respite, transport.	60+, require a nursing facility level of care but have a gross income of $1,656.00 or less/mth & assets of $2000 - $40,000. Assessment by AAA & care provided by list of approved providers. Cost share is 50% of service cost/mth.	Consumer direction Can be consumer-directed Other information Program supplements services provided under the Attendant Care Waiver which was authorized in 1995
PA	Attendant Care Program¹¹,³⁴	Dept of Aging & Dept of Public Welfare	Elderly (59+) Adults with disabilities (18-59)	$47,031,000 (FY04-05) (includes state match for waiver)	N/A	N/A	Chore, companion, homemaker, meals, personal care, transport.	Functional eligibility requirements are the same as for the Medicaid Attendant Care waiver but there is no reported financial eligibility requirement.	Consumer direction Consumer-directed - hire, fire, train & pay personal attendants. Other information Program authorized by the state Attendant Care Act 150, 1986 & supplements Attendant Care waiver services.
PA	Family Caregiver Support Program³,⁴,¹¹,³⁴	Dept of Aging	Elderly (60+) or adults with dementia.	$11,500,000 FY01	General Revenue	8,02 FY02	AT, case management, counseling, education/training, emergency response, info/assistance, legal consultation, medical equipment, modifications/repair, respite, support groups. Eligible caregivers may receive up to $200/mth for out of pocket expenses. One-time grants are available for modifications.	Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid. Assistance on a sliding scale based on income. Person must be 60+ & require help with 2+ ADLs or have dementia if under 60. Limited financial assistance (e.g. equipment not covered by Medicaid) is available for people with income at/below 380% FPL. No asset limit.	Cost control: Cost cap $200/mth. No service limits applied. Quality control: on-site monitoring & data analysis. Consumer direction Can be consumer directed. Other information Supplements the federally funded Family Caregiver Support Program, it started as a demonstration project in 4 counties & spread statewide 1990.
PA	Risk Reduction through Assistive Technology⁴	N/A	Elderly (60+)	$1,000,000 FY02 Appropriation	Tobacco fund	345 FY02	N/A	Income limit $923/mth, no asset limit.
RI	Respite Care⁴	Dept of Elderly Affairs	Elderly (60+), adults with Alzheimer's or related disorders	$424,000 FY02 Appropriation	General Revenue & clients contribute	1,500 FY02	N/A	No income or asset limit.	Cost control Co-pay on sliding scale Other information There may be a small program for Children with Special health care needs, under the Dept of Human Services which provides respite to 300 families.
RI	CoPay Program⁴	Dept of Elderly Affairs	Elderly 65+	$3,029,000 FY02 Appropriation	General Revenue	1,800 FY02	adult day care, case management, HH.	Individuals who do not meet the financial eligibility requirements of Medicaid &/or individuals waiting placement on the Medicaid HCBS program. Income limit FY02 $1,410/mth (tied to state-funded pharmacy program for eligibility). No asset limit.	Cost control: No cost caps. Service limits applied: 20hrs/wk homecare, 6days/wk adult day services. No co-pay required. Quality control: client satisfaction surveys.
SC	Alternative Care for the Elderly⁴	N/A	Elderly 60+	$755,389 FY02 Appropriation	General Revenue, dedicated taxes from Bingo	484 FY02	Case management, homemaker, meals, respite.	Individuals who do not meet the financial eligibility requirements of Medicaid &/or individuals waiting placement on the Medicaid HCBS program or placement in a nursing home or individuals receiving Medicaid HCBS. No income or asset limit.	Cost control: No cost caps. No service limits applied. Co-pay on a sliding fee scale based on self-declared individual income & ability to pay. Quality control: quality assurance standards which are adopted by service providers. Other information There is also a state-funded Eldercare Trust Fund which provides seed money for demonstration projects.32
SD	Long-Term Care Alternatives Program⁴	Dept of Social Services	Elderly & physically disabled Adults	$2,807,363 FY02 Appropriation	General Revenue	1,308 FY02	Adult day care, case management, emergency response, homemaker, meals, medical equipment, personal care, respite.	No income limit. Nursing home level of care. Income & asset limits. Asset limit FY02 $40,000 (individual)	Cost control: Cost caps $850/mth. Service limits: $35/mth rental emergency response system, $35/mth medication management device rental. Co-pay on sliding fee scale. Cost share between the incremental mthly income & cost of a care plan. A $250 expenditure allowed if the household is paying privately for additional services & for medical deductions that exceed $35 in out-of-pocket expenses. Quality control: 6 mth review of clients, annual provider evaluation, meetings with providers and families.
TN	Options for Community Living Program (2001)³,³⁶	Commission on Aging & disability	Elderly & adults with disabilities	$5million FY02	N/A	1292 FY02	In-home, non-medical services - I&A, homemaker, personal care, meals, service coordination.	People who are not usually eligible for Medicaid.	Cost control 2,521 people are on the waiting list. Co-pay based on sliding scale according to income. Other information 30% of participants are non-elderly disabled. There may be a state-funded program 'Home & Community Based LTC for non-Medicaid Elderly & Adults with Disability'.
TX	Respite Care Program³	Dept of Human Services	Adults with dementia (18+)	$1,107,311 FY03	General revenue	N/A	Chore, homemaker, personal care, respite care.	Diagnosis of dementia or related disorder.	Cost control: Service limits applied - respite cap of 336 hours/year
TX	IHFSP³	Dept of Human Services	N/A	N/A	General revenue	N/A	Cash grant	1 ADL or 1 IADL	Other information Funding not appropriated by state legislature for FY04/05
TX	Multi-Service Group⁴	N/A	Elderly 60+	$5,306,470 FY02 Appropriation	General Revenue	N/A	Adult day care, case management, emergency response, homemaker, meals, personal care, respite, transport, .	Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid &/or individuals waiting placement on the Medicaid HCBS program or placement in a nursing home. No income or asset limit.	Cost control: No cost caps. Service limits applied: $300/quarter respite. No co-pay required.
UT	Home & Community-Based Alternatives Program³,⁴,³⁷	Dept of Human Services, Div. of Aging & Adult Services	Elderly 60+ & physically disabled adults (10% of clients were under 60 in FY03)	$3,909,906 FY05	General Revenue & clients contribute	2,012 FY05	Adult day care, case management, chore, emergency response, education/training, homemaker, HH, info/assistance, meals, medical equipment, modifications/repairs, personal care, respite, skilled nursing, support groups, transport.	People at risk of institutionalization with mobility/functional limitations. Individuals who do not meet the financial eligibility requirements of Medicaid &/or individuals waiting placement on the Medicaid HCBS program. Income limit FY02 $738/mth (100% FPL). Asset limit FY02 $6,000 (individual)	Cost control: Cost cap $750/mth. No service limits applied. Co-pay on sliding scale based on income & family size. Quality control: annual monitoring of documentation & client interaction. Consumer direction Can be consumer directed. Other information Most clients are 60+. Funding limitations & lack of providers restrict services provided across the state. Annual av. cost per client $2,202. Family members can be paid.
VA	Respite Care Initiative Grant³	Dept on Aging	Elderly (60+)	N/A	General revenue, county & local funds, clients contribute.	N/A	Chore, homemaker, personal care, respite.	Diagnosis of dementia or related disorder.
VA	Respite Care Grant Program³	Dept on Aging	N/A	N/A	General revenue, clients contribute, other public &/or private funds	N/A	Respite, transport.	Nursing home level of care, physically disabled.
VA	Home-Delivered Meals⁴	Dept on Aging	Elderly 60+	$3,406,545 FY02 Appropriation	General Revenue, clients contribute	N/A	N/A	No income or asset limits.	Cost control Co-pay on a sliding scale.
VA	Transportation⁴	Dept on Aging	Elderly 60+	$910,099 FY02 Appropriation	General Revenue, clients contribute	N/A	N/A	No income or asset limits.	Cost control Co-pay on a sliding scale.
VA	Community-Based Services Program⁴	Dept on Aging	Elderly 60+	$6,283,166 FY02 Appropriation	General Revenue	N/A	Adult day care, chore, homemaker, personal care, respite.	No income or asset limit.	Cost control: Co-pay required, some local AAAs operate their HCBS on a fee-for-service basis & charge people using a sliding fee scale.
VT	The Homemaker Program⁴,³⁸	Dept of Aging & Disabilities	Elderly & Physically disabled adults.	$801,741 FY02 Appropriation	General revenue, clients contribute + Federal funds (SSBG)	851 FY02	Homemaker	People who need assistance with 1/more ADLs &/or have cognitive impairment. No income or asset limit.	Cost control Co-pay on a sliding scale.
VT	Attendant Services Program: (a) Participant Directed Attendant Care & (b) Personal Services⁴,³⁸	Dept of Aging & Disabilities	Elderly & Physically disabled adults.	$3,448,283 FY02	General Revenue	186 FY02	Personal care	Participant Directed Attendant Care People with a severe & permanent physical disability & need assistance with 2/more ADLs. No income or asset limit Personal Services People requiring support with at least 1 ADL or meal preparation & are Medicaid eligible. No income or asset limit	Consumer direction Participant Directed Attendant Care: Service users hire, train & supervise their attendant provider. Spouses or civil union partners can be employed in this role. Personal Services: An agency can be employed to direct the attendant if the client doesn't want to do it themselves. A spouse or civil partner may be employed. Other information Another state-only program has legislative approval, should funding become available. The Group directed Attendant Care Program is part of the Attendant Services Program.
VT	Housing & Supportive Services Program⁴,³⁸	Dept of Aging & Disabilities	Elderly 60+ & Physically disabled adults	$550,000 FY02	General revenue	713 FY02	Adult day care, homemaker, chore, case management, medical equipment, personal care, skilled nursing, transport.	Individuals in congregate housing settings who do not meet the financial &/or functional eligibility requirements of Medicaid &/or individuals waiting placement on the Medicaid HCBS program or placement in a nursing home or individuals receiving Medicaid HCBS. Income limit varies. No asset limit.	Cost control: No cost caps. No service limits applied. Co-pay on sliding fee scale or suggested donation (varies by site). Consumer direction Can be consumer directed. Quality control: quality outcomes, client satisfaction survey. Other information Coordinates access to existing services & last resort to finance services for people at risk of institutionalization.
VT	Adult Day Services⁴	Dept of Aging & Disabilities	Elderly 60+, disabled	$1,038,786 FY02 Appropriation	General Revenue & clients contribute	978 FY02	Adult day care, meals, personal care, transport, respite.	Each day center defines its own income and asset limits & sliding fee scale.
WA	Chore Services Program (1970s)¹,¹⁹,³⁹	Aging & Adult Services Administration in Dept of Social & Health Services	Elderly, physically disabled.	$2,800,000 FY00	N/A	539 av. monthly caseload FY00	Chore, personal care.	Require help with at least 1 personal care task & at risk of nursing home placement. Low income but not eligible for other programs (e.g. Medicaid). Less than $10,000 in assets (individual).	Cost control hrs controlled. Co-pay on sliding fee scale. Consumer direction Consumer direction required for people receiving 112 hours+ support/mth.
WA	Residential Care Program (1970s)¹,¹⁹,³⁹	Aging & Adult Services Administration in Dept of Social & Health Services	Elderly, physically disabled.	$300,000 FY00	N/A	56/mth av. FY00	Chore, personal care.	Require help with at least 1 personal care task & at risk of nursing home placement. Low income but not eligible for other programs (e.g. Medicaid). Less than $10,000 in assets (individual).	Cost control hrs controlled. Co-pay on sliding fee scale. Consumer direction Consumer direction required for people receiving 112 hours+ support/mth.
WA	Family Caregiver Support Program³,⁴	Dept of Social & Health Services	Adults with dementia (18+)	$631,532 FY03	General Revenue	1,354 FY02	Adult day care, AT, chore, consumer supplies, education/training, emergency response, homemaker, info/assistance, legal/financial consultation, medical equipment, modification, personal care, respite, support groups, transport.	Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid &/or individuals waiting placement on the Medicaid HCBS program. No income or asset limit.	Cost control: No cost caps. Service limits applied: 120-500hrs/yr respite, $500-1000/yr supplemental services. Quality control: quarterly data & reports, caregiver satisfaction surveys, caregiver advisory councils.
WA	Respite Care Program³,⁴	Dept of Social & Health Services	Physically disabled adults (18+) or adults with dementia	$3,700,941 FY03	General revenue, clients contribute.	N/A	Respite	Diagnosis of dementia or related disorder.	Consumer direction Co-pay on a sliding scale.
WI	Community Options Program Regular (COP-R)⁴,⁴⁰	Dept of Health & Family Services Division of Supported Living, Bureau of LTC resources	Elderly, physically disabled, MR/DD	$61,300,000 FY99	General Revenue	2,254 FY02	Adult day care, chore, case management, emergency response, habilitation, HH, homemaker, meals, medical equipment, modifications/repair, personal care, respite, skilled nursing, transport,	Individuals not requiring nursing home care & people with too high an income. Income limit FY02 $669/mth (individual) & a 6month resources allowance at/below $27,733. Also covers people likely to become eligible for Medicaid within 6 mths of entering a nursing home. Uses Medicaid COP spousal impoverishment & transfer of assets rules.	Cost control: No cost caps. No service limits applied. Co-pay on a sliding fee scale determined by a cost share formula. Quality control: interviews, outcomes. Consumer direction Can be consumer directed. Other information Any service necessary permitted which supports client to live in community.
WI	Family Support Program⁴⁰	Dept of Health & Family Services.	Families with a child with severe disabilities	N/A	N/A	N/A	Information & referral, funding for goods & services,	Families of children under 21 with a severe mental, physical or emotional disability which limits ADLs & are living at home.
WI	Alzheimer Family & Caregiver Support Program³	Dept of Health & Family Services	N/A	$1.9 million FY03	General revenue	N/A	AT, cash grants, case management, chore, consumer supplies, counseling, education/training, emergency response, homemaker, info/assistance, legal/financial assistance, modifications/repairs, personal care, respite, transport.	Diagnosis of dementia or related disorder.	Cost control Respite cap $4000/year. Other information Family members can be paid to provide care.
WI	Elderly Nutrition⁴	Dept of Health & Family Services	Elderly 60+	N/A	General Revenue	N/A	N/A	No income or asset limits.
WV	WV Family Support Program⁴¹	Bureau for Behavioral Health & Health Services.	Families with a child or adult with DD	More than $1million	State appropriation, private donation.	Approx. 2,000 families FY03	Service identification, information & referral. Funds for goods, services & home modifications, other support services.	Family Support Council reviews applications & determines how funds will be allocated to families.	Other information Av. expenditure per family is $1,000. Funds are limited. 14 regional Family Support Councils, each with a family support coordinator. 80% of state funds & 90% of private donations go to services.
WV	Community Care Program⁴	N/A	18+ (majority of clients age 60+)	$700,000 FY02 Appropriation	State Lottery & clients contribute	491 FY02	N/A	No income or asset limits.	Cost control Co-pay on a sliding scale.
WY	State Child Respite Program⁴²	Dept of DD	Children with DD	$125,000	State & co-pay	62	Respite (hourly units).	Under 21, severe, chronic disability needing assistance with 3/more ADLs	Cost control: Co-pay based on parental income.
WY	Community-based In-Home Services Program³,⁴	Dept of Health	Elderly 60+, physically disabled adults 18+	$1,901,155 FY02 Appropriation	General Revenue & Clients contribute + Federal funds (OAA TitleIIIE)	16,665 FY02 (may include federally funded clients)	Adult day care, case management, chore, emergency response, homemaker, medical equipment, modifications/repair, personal care, respite.	Individuals who do not meet the financial &/or functional eligibility requirements of Medicaid &/or individuals waiting placement on the Medicaid HCBS program or placement in a nursing home or individuals receiving Medicaid HCBS. No income or asset limit.	Cost control: No cost caps. Service limits applied: $300 one time modifications. Co-pay on a sliding fee scale. Quality control: annual assessment of each grantee receiving funds. Consumer direction Can be consumer directed.

Abbreviations:

AAAs: Area Agencies on Aging.
ADL: Activities of Daily Living.
AT: Assistive Technology. Dept - Department.
FY: Financial Year.
HCBS: Home & Community-Based Services.
LTC: Long Term Care.
Mth: Month.
Rehab: Rehabilitation.
SCI: Spinal Cord Injury.
SSBG: Soical Services Block Grant.
TBI: Traumatic Brain Injury.
Wk: Week.
Yr: Year.

Footnotes:

(a) Note that some figures listed are the yearly appropriation, not expenditure.

(b) Sources of funding are listed in the language with which they are reported.

Notes:

(1) The definitions of the services provided in programs may differ between states.

(2) Unless otherwise stated, programs are statewide.

(3) Programs where it is known that funding may come from a variety of sources, including non-state only funds (e.g. Older Americans Act) are indicated by the program name in italics.

(4) The table does not include Mental Health Services programs.

(5) All information is the most up-to-date found from secondary sources noted in the references.

(6) N/A means the information has not been found (not available).

(7) all programs primarily aim to support people to live in the community, therefore there may be additional state only funded programs but these are not directly to support HCBS.

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