Aged/Disabled Home and Community Based Services (HCBS) Medicaid Waiver

Summary

This program provides community-based services to aged and disabled clients who are functionally impaired and at risk of nursing home placement. The program assists clients to remain in their own homes. Clients must meet financial and physical eligibility requirements. A case manager is assigned to each client. Examples of services provided through the HCBS waiver are Adult Day Health Care, Case Management, Chore, Counseling, Home Delivered Meals, Homemaker, and Personal Care.

History

The Social Security Act under Title XIX allows for federal funds to be provided to States for medical assistance programs. A waiver has been granted to the State of Florida where certain Title XIX requirements have been waived in order to provide special Medicaid services to a group of people who meet specific financial and technical eligibility. The purpose of the Medicaid Waiver Program is to provide services to allow persons who would otherwise need nursing home care to remain in the community.

The Waiver is administered and managed by the Department of Elder Affairs (DOEA) and locally by the Area Agency on Aging. DOEA is responsible for development of policies related to the provision of HCBS service for the elderly. The Department of Children and Families (DCF) determines financial eligibility for the Institutional Care Program (ICP) level for elderly and disabled adults. Community Care for the Elderly (CCE) and Community Care for Disabled Adults (CCDA) lead agencies employ case managers to assess applicants for entry to the Waiver Program.

Assisted Living Medicaid Waiver

Summary

The Assisted Living Medicaid Waiver Program provides community-based services to frail functionally impaired seniors and disabled clients age 60 and over at risk of nursing home placement. Clients, who must meet financial and physical eligibility requirements, live in an assisted living facility and receive services suitable to their needs. A case manager is assigned to each client. Examples of services that may be provided by the Assisted Living Facility under the Waiver are Adult Resident Care, Behavior Management, Case Management, Medication Management, Medical Supplies, and Nursing Services.

History

Title XIX of the Social Security Act authorizes federal funds to be provided for medical assistance programs. The State of Florida has been granted a waiver of certain Title XIX requirements in order to provide special Medicaid Services to specified groups of people. The Assisted Living Medicaid Waiver provides personal care and supervision services to allow persons who would otherwise need nursing home care to remain in an Extended Congregate Care (ECC) or Limited Nursing Services (LNS) Assisted Living Facility.

The Assisted Living Waiver is administered and managed by the Department of Elder Affairs, Area Agencies on Aging, Department of Children & Families, Agency for Health Care Administration and local services providers. All service providers and service recipients must meet certain eligibility criteria in order to participate in the Assisted Living Medicaid Waiver.

Alzheimer’s Disease Initiative (ADI)

Summary

The Alzheimer’s Disease Initiative (ADI) program provides community-based services for the special needs of individuals aged 18+ with Alzheimer’s disease and related memory disorders. There is a co-pay fee required of clients receiving services. Examples of services provided are case management, respite care and caregiver training & support.

History

In 1985, the Florida state legislature created The Alzheimer’s Disease Initiative to provide services and training to meet the special needs of individuals suffering from Alzheimer’s disease and related memory disorders. ADI also provides funding for caregiver needs.

ADI has four major components, each of which is devoted to meeting the service, research and training needs of Floridians stricken by Alzheimer’s disease and related dementia. These components are: A ten member advisory committee appointed by the Governor; eight memory disorder clinics located throughout Florida; Model Day Care programs, and Respite Care Programs.

Legislative changes made to ADI by the Florida Legislature over the years include the addition of two Memory Disorder Clinics, a requirement for providers to collect co-pay fees for service, and the provision of caregiver training as a new service. Within PSA 5, respite care is a funded service under ADI and is provided by the lead agencies in Pasco and Pinellas counties.

ADI funds are administered through the Department of Elder Affairs. Area Agencies on Aging are responsible for administering funds at the local level. Since 1985, the Area Agency on Aging has assumed responsibility for administering ADI funds for PSA 5.

Services of the ADI program focus on providing respite care for caregivers of persons suffering from Alzheimer’s disease or other related dementia, offering them some weekly relief from the constant demands of caregiving. ADI services help eligible consumers to remain in their homes or the home of a caregiver rather than relocating to an institution or nursing home because of unmet personal care needs.

Community Care for the Elderly Act (CCE)

Summary

Community Care for the Elderly provides community-based services to assist seniors aged 60+ at risk of nursing home placement to remain in their homes or the home of a caregiver rather than relocating to an institution because of unmet personal care needs. Clients must be homebound and live in the community, but require help from others to cope with the normal demands of daily living. A co-payment fee is charged for all services received based on the client’s ability to pay. A case manager is assigned to each client. Examples of services provided are adult day care, case management, emergency alert response, home delivered meals, home nursing, and nutrition counseling.

History

In 1973, the Florida Legislature demonstrated its commitment to meet the special needs of Florida’s aging citizens by passing the Community Care for the Elderly (CCE) Act. This Act was amended in 1976, authorizing the funding and implementation of demonstration projects to determine acceptable and cost-effective ways of keeping elderly persons in their own homes to prevent, postpone or reduce inappropriate or unnecessary institutional placements.

Community Care for the Elderly provides community-based services organized in a continuum of care to assist elders, aged 60+, at risk of nursing home placement to live in the least restrictive environment suitable to their needs.

In 1980, the Legislature amended the CCE Act and expanded CCE from a demonstration project to a statewide program for functionally impaired older people. The bill provided for the development of at least one community care service system in each district.

Individuals must be functionally-impaired and age 60 or older. “Functionally impaired,” according to the Community Care Act, refers to persons who are homebound and live in the community, but require help from others to cope with the normal demands of daily living.

CCE funds are administered through the Department of Elder Affairs and Area Agencies on Aging are responsible for administering funds at the local level. Since 1980, the Area Agency on Aging has assumed responsibility for administering CCE funds in Pasco and Pinellas counties.

Home Care for the Elderly (HCE)

Summary

This program provides subsidy payments to help caregivers maintain low-income seniors in their own home or in the home of a caregiver. The senior must be at risk for nursing home placement. The monthly subsidy payment is made to the caregiver for support and health maintenance and to assist with specialized health care needs.

History

Home Care for the Elderly (HCE) seeks to prevent premature or inappropriate institutionalization by helping caregivers of frail, low-income seniors. HCE provides a financial subsidy to caregivers of persons aged 60+ who are eligible for nursing home care through Medicaid, but who are receiving care in a family-type living arrangement in the community.

There are two types of HCE subsidies. Basic subsidy is a set monthly payment made to the caregiver to assist with the general cost of providing care. The payment amount is based on the income of the person receiving the care, but is generally $106 per month. Special subsidy is a flexible payment that reimburses caregivers for purchases of special supplies, equipment, or services needed to maintain the health and well-being of the elderly person. This supplement is not received by every HCE client and varies in amount per month. HCE is managed by the lead agency in each county and subsidy payments are made through the Area Agency on Aging.

Older Americans Act (OAA)

Summary

The federally funded Older Americans Act provides a variety of in-home and community-based services without cost to persons 60+. While people 60 years of age and older are eligible for Older Americans Act programs, services are funded for individuals with the greatest economic and social need who meet program guidelines. Also provides support services for family caregivers and grandparents or older individuals who are relative caregivers. Examples of Older Americans Act services are Information and assistance, Home-delivered meals, Adult Day Care, Counseling, and Transportation.

History

The Older Americans Act is generally considered to be the most significant federal recognition of the distinct needs, capabilities and privileges which are inherent in a specific group, i.e., those aged 60 and over. The activities, mandated and funded under this Act, carry no income eligibility requirement, unlike numerous other federal assistance programs, e.g., food stamps and Section 8 housing. The Older Americans Act is viewed as a direct outgrowth of the 1960 White House Conference on Aging.

The overall purpose of the Act was to establish an “aging network,” provide for the funding of local service programs, establish training and research projects, and stimulate the development of innovative and/or improved services for the elderly. Congress has continued to appropriate funds and update the law with periodic amendments under this Act for the provision of social and nutritional services, staff training, research/demonstration projects, and the operation of the Administration on Aging. In the fall of 2000, the OAA was reauthorized and amendments added for a five year period. According to the amendments of 2000, funds can be utilized as follows:

Title III-B: Supportive Services and Senior Centers
Title III-C-1: Congregate Nutrition Services
Title III-C-2: Home-Delivered Nutrition Services
Title III-D: Disease Prevention and Health Promotion Services
Title III-E: National Family Caregiver Support Program

Under the Older Americans Act, service providers must follow priorities set by the Area Agency for serving older persons with greatest economic or social need, with particular attention to low-income minority older persons and older individuals residing in rural areas, individuals with severe disabilities, and Native Americans. The Older Americans Act requires that each client be provided the opportunity to contribute to the cost of the service; however, denial of service for non-contribution is prohibited. Contributions must be used to expand services

The revised Older Americans Act added a new caregiver title to the Act. This title provides an infrastructure of program resources and assistance to family caregivers and grandparents and older individuals who are relative caregivers through state and area agencies on aging, service providers and consumer organizations.