Public Financing of Home and Community Services for Children and Youth with Serious Emotional Disturbances: Selected State Strategies

Strengthening the financing of intensive home and community services for youth with serious emotional disorders (SEDs) brings into play a complex set of policy issues, regulatory constraints, and payment mechanisms. This report presents critical background information on these topics. It describes important system-of-care principles that have shaped the services for youth with SEDs, the role of the various agencies that serve these children, and the financing mechanisms used by many states. The report also identifies the general financing themes that emerged in our discussions with officials in each of the three groups of states. It covers the strengths and weaknesses of four major financing mechanisms: HCBS waivers, the Medicaid rehabilitation option, case rates for high risk populations, and provisions in the Tax Equity and Fiscal Responsibility Act (TEFRA), also known as the Katie Beckett provision. Finally, the report presents a synthesis of findings with respect to the research questions and discusses what the findings may imply for current legislative efforts to strengthen the financing of intensive home and community services for youth with SEDs and their families. [179 PDF pages]