Case Studies of Six State Personal Assistance Service Programs Funded by the Medicaid Personal Care Option. I. Program Overview: Size of Population and Expenditures, Program Objectives


The Medical Assistance Personal Care (MAPC) program is administered by the Long Term Care Division of the Department of Health and Mental Hygiene (DHMH). The program budget was $14.8 million in FY 1989, and served 5254 people. Program expenditures are projected to be roughly $19.9 million in FY 1991, but the state has asked the DHMH to look at ways to cut the program budget by 13 % to 50 %. Roughly 10% of program expenditures goes to case monitoring functions, and 2.5 % to administration. The remainder goes to provider pay.

The program serves Medicaid eligible people who live at home and need assistance with activities of daily living (ADLs). The program assigns recipients to three levels of need: some daily ADL needs (level I), extensive ADL needs (level II), and ADL needs at all times (level III). The program pays independent providers a daily rate of $10 for level I recipients, $20 for level II recipients, an $25 for level III recipients. Functional eligibility determination, needs assessment and case-management are perform by independent RNs or RNs working for county public health departments.

The program's objectives are to support informal caregivers and prevent or delay institutional placement. There is widespread dissatisfaction with the program's current structure on the part of the state providers, providers, consumers and advocates. This dissatisfaction, in the context of Maryland's fiscal crisis, suggests that major program policy changes are possible in the near future.

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