Home and Community-Based Services for Older People and Younger Adults with Physical Disabilities in Maryland

HOME AND COMMUNITY-BASEDSERVICES FOR OLDER PEOPLE ANDYOUNGER ADULTS WITH PHYSICALDISABILITIES IN MARYLANDFinal ReportPrepared for:U.S. Department of Health and Human ServicesHealth Care Financing AdministrationPrepared by:Jane Tilly and Jessica KastenThe Urban InstituteThe Lewin GroupFebruary 26, 2001 HOME AND COMMUNITY-BASEDSERVICES FOR OLDER PEOPLE ANDYOUNGER ADULTS WITH PHYSICALDISABILITIES IN MARYLANDFinal ReportPrepared for:U.S. Department of Health and Human ServicesHealth Care Financing AdministrationPrepared by:Jane Tilly and Jessica KastenThe Urban InstituteThe Lewin GroupFebruary 26, 2001 This research was supported by Health Care Financing Administration ContractNo. 500-96-0005. In this contract, the Urban Institute is a subcontractor to the LewinGroup. The opinions expressed in the report are those of the authors and do notnecessarily reflect the position of the Health Care Financing Administration or the UrbanInstitute. Table of ContentsINTRODUCTION.........................................................................................................................................................1THE LONG-TERM CARE SYSTEM IN MARYLAND....................................................................................2PROGRAMS AND ADMINISTRATIVE STRUCTURE...................................................................................3ELIGIBILITY CRITERIA AND ASSESSMENT..............................................................................................10CASE MANAGEMENT AND SERVICE PLANNING....................................................................................12SERVICES.....................................................................................................................................................................13CONSUMER DIRECTION......................................................................................................................................14COST CONTAINMENT............................................................................................................................................15QUALITY ASSURANCE..........................................................................................................................................16FEDERALISM ISSUES.............................................................................................................................................18ISSUES FOR THE FUTURE....................................................................................................................................18 Final Report1261699INTRODUCTIONMaryland, a fairly small mid-Atlantic state with about five million people in1999,1 has 12 home and community services programs for older persons and adults withphysical disabilities. Maryland’s Medicaid program provided home and communityservices to approximately 5,100 beneficiaries through the optional personal care benefitand 4,600 beneficiaries through its optional medical day care program in fiscal year 1999.The state has one currently operating Medicaid waiver for older adults with 135 slots,which will be expanded to 1,135 slots in 2001. The state will implement another waiverin 2001 with 150 slots in the first year for non-elderly adults with physical disabilities.The state also has eight small, state-funded home and community services programsdesigned to serve adults who are not eligible for Medicaid. The state has a complexadministrative structure for its home and community services programs, with several stateand local agencies involved.Maryland’s home and community services programs have grown over the years.The state’s new Medicaid waiver and the recently expanded waiver will result inincreased coverage for community services. Maryland has some innovative programs,including a Program of All-Inclusive Care for the Elderly (PACE) site.This paper addresses the home and community services system for older peopleand younger adults with physical disabilities in Maryland, focusing on the stateadministrative structure, eligibility and assessment, services covered by Medicaid andother programs, cost containment, and quality assurance. This report also summarizesgovernment officials’ and key stakeholders’ opinions about how well the Medicaid andstate-funded programs serving the aged and disabled work.Information was obtained from public documents, state of Maryland web sites,and interviews with state officials, consumer representatives, and provider associations.Interviews were conducted in person in Washington, DC and Baltimore, Maryland, in 1 http://www.census.gov. Final Report2261699February and March 2000, respect