Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Long Term Care Programs Funded with State Revenues Only


The state has three major programs for elderly persons funded solely by state general revenues, namely, Alzheimer's Disease Initiative, Community Care for the Elderly, and Home Care for the Elderly.9 Local areas, called Planning and Service Areas, provide a range of services that are instrumental in keeping frail elders out of nursing homes, including: Personal Care, Homemaker, Chore, Respite, Case Management, Skilled Nursing, Home Health Aide, Home Delivery Meals, Transportation, Adult Day Care, Emergency Alert Response, and Home Repair and Modifications.

Alzheimer's Disease Initiative (ADI) provides services to people with Alzheimer's Disease and other types of dementia who do not meet Medicaid financial criteria or who are waitlisted for HCBS waiver services. Respite services are provided to caregivers in all 67 counties of the state, with a service limit of 30 consecutive days for extended (24 hour) respite.

Although there is no income eligibility ceiling for ADI, cost sharing is required, beginning at 150 percent of FPL and ending at 300 percent FPL, at which point the consumer pays 100 percent of costs. If assets are over $2,000, 5 percent of the value divided by 12 is added to the monthly income amount. The maximum cost-sharing amount that an individual pays is 15 percent of adjusted monthly income.

Community Care for the Elderly (CCE) is a program for frail elderly persons, age 60 and older, who do not meet Medicaid financial or service criteria, or who are waitlisted for HCBS waiver services. Eligibility is based, in part, on a client's inability to perform certain daily tasks essential for independent living, such as meal preparation, bathing, or grooming. This program provides case management along with additional home and community services. Financial eligibility criteria are the same as for the ADI program and cost sharing is required on the same sliding scale basis. Agencies may use the CCE program while waiting for a waiver slot, but sometimes the CCE program also has a waiting list.

Home Care for the Elderly (HCE) provides a subsidy ($104 per month in 2002) to help relatives keep a low-income elderly person in their own home or in the home of a caregiver. There is also a special subsidy available as a supplement for specialized health care needs. The program serves individuals aged 60 or older who do not meet Medicaid service criteria. HCE has an income eligibility ceiling of $1,635 per month (300 percent of SSI) with an asset limit of $2,000 in countable assets. An eligible HCE participant must be at risk of nursing home placement.10

  1. The financial and service eligibility information is taken from Kassner, E. and Williams, L., Taking Care of their Own: State-funded Home and Community-based Care Programs for Older Persons, AARP, September 1997. Other details of the programs are from the Department of Elder Affairs website and personal communications.

  2. One respondent felt that this program is more cost effective than the waiver program in preventing nursing home placement because many caregivers become financially dependent on the subsidy, which while not large, can be critical for a poor family. If this situation occurs, it may not always be in the best interests of the elderly person who needs services that the family can not provide.


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