Home and community-based services in seven states

Area of Science:

• Health Services Research
• Public Health Policy
• Gerontology

Background:

• Home and community-based services (HCBS) are crucial for older adults and individuals with physical disabilities.
• Understanding the structure and financing of HCBS is essential for effective policy and service delivery.
• Medicaid plays a significant role in funding and shaping HCBS across the United States.

Purpose of the Study:

• To assess the key features of HCBS systems in seven US states.
• To analyze the financing, administration, and service delivery of HCBS.
• To investigate the specific role of Medicaid in HCBS for diverse populations.

Main Methods:

• Conducted case studies in Alabama, Indiana, Washington, Wisconsin, Maryland, Michigan, and Kentucky.
• Analyzed service financing, administrative structures, and eligibility determination processes.
• Examined service provision, including consumer-directed care and residential options, cost-containment, and quality assurance.

Main Results:

• Identified variations in HCBS system structures and financing across the studied states.
• Highlighted the significant impact of Medicaid on the availability and scope of HCBS.
• Observed diverse approaches to service delivery, cost containment, and quality assurance.

Conclusions:

• State-specific factors significantly influence HCBS systems for older adults and individuals with physical disabilities.
• Medicaid's role is central to the provision and sustainability of HCBS.
• Further research is needed to optimize HCBS delivery and ensure quality across diverse populations.