Policy Issues Affecting the Medicaid Personal Care Services Optional Benefit

The project examined how states have used Medicaid's Personal Care Services Optional Benefit (also called the PC Option), assessed whether coverage regulations for these services be revised, and discussed the ways in which the program might affect public debate about the expansion of public funding for long-term care. The project entailed reviewing survey data and conducting case studies of six states' PC Option programs. Findings include that: (1) some programs funded only a small part of the state's long-term care services, while others were the only source of personal assistance service in the state; (2) many programs have experienced a high rate of growth and have become major sources of public funding for home and community-based long-term care services; (3) caseloads are growing because the programs serve diverse populations; however, states also are under pressure to contain personal assistance service costs; and (4) disability rights advocates want a service delivery system that facilitates independence and maximizes consumer involvement in personal assistance service, but this type of system challenges the "medical model" of service delivery. Policy options include: (1) eliminating disparities in the provision of services by making personal assistance service mandatory under Medicaid; (2) shifting a percentage of current Medicaid expenditures from institutional services to home and community-based services; and (3) reallocating long-term service expenditures through the 1915(d) home and community-based waiver. [193 PDF pages]