Designing the Cash and Counseling demonstration and evaluation

Coverage of personal assistance services for Medicaid program participants with long-term functional disabilities has been available since the late 1960s, but, during the 1980s, coverage options were expanded and more states elected to offer these services. Over the past quarter century, program participants' access to these benefits has greatly expanded. When personal care services (PCS) were first offered as an optional state plan benefit, in 1968, coverage was limited to in-home aide services and followed a "medical model" that required physician authorization and nurse supervision. Congress eliminated these federal requirements in 1993 in response to a campaign by disability-rights activists. They successfully argued that, whereas medical conditions cause disability and make PCS medically necessary, which provides the rationale for medical insurance coverage, a physician is not needed to make a disability determination and PCS themselves are not "medical" and should not be regulated as such. Nevertheless, many states continued to mandate physician authorization and nurse supervision and, as of the mid-1990s when the CCDE was being designed, approximately half of the 33 states and federal territories offering Medicaid PCS stipulated that only licensed home health care agencies could provide them.

Connecting Tags; LTC, community-based, social production, choice, fan-the-flame, copower, prosynergy