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Home & Community-Based Services: State-Only Funded Programs in Maryland

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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Program Name: Adult Day Care Home Services Grant¹,²¹

Administrative Agency: Dept of Health & Mental Hygiene

Population Served: Elderly, Physically disabled adults

Annual Expenditure: $2,778,862 FY99

Funding Source: General revenue, clients contribute

Number of People Served: 750 FY99

Eligibility Criteria: Non-Medicaid eligible adults 55+ with functional limitations at risk of institutionalization. Sliding scale co-pay scheme taking family size & income into account.

Further Information: Cost control limited state appropriation. Quality control Professional certification requirements, background checks. Consumer direction Can be consumer directed.

Program Name: Senior Care Program¹,²¹

Administrative Agency: Dept of Aging

Population Served: Elderly (65+)

Annual Expenditure: $6,573,000 (FY99)

Funding Source: General revenue

Number of People Served: 3702 (FY 1999)

Eligibility Criteria: 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.

Further Information: 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.

Program Name: Attendant Care Program¹,²¹

Administrative Agency: Department of Disabilities

Population Served: Physically disabled adults (18-64years)

Annual Expenditure: N/A

Funding Source: N/A

Number of People Served: 93 FY01

Eligibility Criteria: 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.

Further Information: 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

Program Name: Social Services to Adults¹,²¹

Administrative Agency: Dept of Human Resources

Population Served: Physically disabled adults (18+)

Annual Expenditure: N/A

Funding Source: N/A

Number of People Served: N/A

Eligibility Criteria: Need help with ADLs, supervision or general help to stay in the community. Means tested if under 65.

Further Information: Quality control local Social Services Depts.

Program Name: Project Home¹,²¹

Administrative Agency: Dept of Human Resources

Population Served: Physically disabled adults (18+)

Annual Expenditure: N/A

Funding Source: N/A

Number of People Served: 1726 FY01

Eligibility Criteria: Need help with ADLs, supervision or general help to stay in the community. Means tested.

Further Information: Cost control 20hrs/week cap. Quality control local Social Services Depts.

Program Name: In-home Aide Services¹,²¹

Administrative Agency: Dept of Human Resources

Population Served: Physically disabled adults (18+)

Annual Expenditure: N/A

Funding Source: N/A

Number of People Served: N/A

Eligibility Criteria: Need help with ADLs, supervision or general help to stay in the community. Means tested.

Further Information:

Program Name: Respite for caregivers of adults with functional disability³

Administrative Agency: Dept of Human Resources

Population Served: Physically disabled adults (18+)

Annual Expenditure: N/A

Funding Source: General revenue

Number of People Served: N/A

Eligibility Criteria: 3+ ADLs

Further Information: Cost control Respite cap 164hours/year.

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.

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.

(c) The figures for number of participants are not necessarily figures for unduplicated participants.

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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