Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Overview


The Community Based Alternatives (CBA) waiver program provides home and community services to persons age 21 and older who qualify for nursing facility care. The goal of the CBA waiver program is to provide individuals with meaningful choices regarding long term care services. Waiver funds are used to allow individuals to avoid premature nursing facility placement and to provide current nursing facility residents an opportunity to return to a home or community living arrangement.

The CBA waiver program currently serves 32,793 persons and has more than 39,000 on an interest list. Placement on an interest list means potential clients have declared an interest in a program for which funding is limited, but have not yet been assessed for financial or service eligibility. The list has an attrition rate of a few thousand per month. The waiting period from the time people get on the interest list to receiving services is approximately 10 months. Eligible individuals are enrolled from the CBA waiver interest list on a "first come, first served" basis.

Within the constraints imposed by the cost ceiling on a participant's Individual Service Plan, the waiver program promotes the participant's active involvement and choices regarding the services provided. Participants may choose to live in their own homes or in a residential care setting covered under the waiver: Adult Foster Care homes or Assisted Living/Residential Care facilities. A waiver participant needing nursing care may choose to have that care delivered by a licensed nurse or, in those situations where delegation is appropriate, by an unlicensed person providing services under the direction of a registered nurse.

The majority of services offered under the CBA waiver program are provided by licensed home and community support services agencies. These agencies provide services to participants living in their own homes, adult foster homes, assisted living/residential care facilities (formerly known as personal care facilities), and other locations where services are needed.

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