Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. STAR+PLUS Long Term Care Services

12/01/2003

All clients receiving long term care services under STAR+PLUS receive care coordination for acute and long term services from the HMO. Care Coordination services include the development of an individual plan of care with the client, family members and provider, and authorization of long term care services for the client.

Long term care services provided by the HMOs include day activity and health services, personal attendant services, and short-term (up to 4 months) nursing facility care. Additional services provided to CBA waiver clients are adaptive aids, adult foster home services, assisted living/residential care services, emergency response services, medical supplies, minor home modifications, nursing services, respite care and therapies (occupational, physical and speech-language). Approximately 200 clients are receiving services in assisted living facilities.7

In 1998, the State amended the CBA waiver program to create a new waiver program specifically for Harris County (in effect, there are now two 1915(c) waiver programs in Texas). The providers contract with the HMOs and, as much as possible, deliver the same services as the CBA waiver program, by way of a capitated payment from the CBA waiver budget for Harris County. There is no waiting list. The HMOs may also provide additional "value-added" services, such as CBA waiver services to clients living in the community but not in a CBA waiver slot.


7. The respondent who provided this figure stated that it is a conservative estimate based on incomplete data, and that a larger number is probably being served in these settings.

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