Estimating the expense of a mandatory home-and community-based personal assistance services benefit under Medicaid.
Personal assistance services (PAS) are essential for many people of all ages with significant disabilities, but these services are not always available to individuals at home or in the community, in large part due to a significant bias toward institutions in the Medicaid program. This study aims to provide an estimate of the expense of a mandatory personal assistance services (PAS) benefit under Medicaid for persons with low incomes, low assets, and significant disability.


METHODS
We use year 2003 data from the Survey of Income and Program Participation to estimate the number of people living in households who would be eligible, based on having an institutional level of need and meeting financial criteria for low income and low assets, combined with additional survey data on annual expenditures under Medicaid programs providing PAS.


RESULTS
New expenditures for PAS are estimated to be $1.4-$3.7 billion per year (in 2006 dollars), depending on the rate of participation, for up to half a million new recipients, more than a third of whom would be ages 65 and older. These estimated expenditures are a tenth of those estimated by the Congressional Budget Office for implementing the Medicaid Community-Based Attendant Services and Supports Act (MiCASSA).


CONCLUSIONS
Creating a mandatory PAS benefit for those with an institutional level of need is a fiscally achievable policy strategy to redress the imbalance between institutional and community-based services under Medicaid.
LaPlante
Mitchell P
MP
Institute for Health & Aging, University of California, San Francisco, CA 94118, USA. mitch.laplante@ucsf.edu
Kaye
H Stephen
HS
Harrington
Charlene
C
D000368:Aged; D006233:Persons with Disabilities; D004608:Eligibility Determination / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000191:economics; D006704:Homemaker Services / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D008134:Long-Term Care / Q000191:economics / Q000458:organization & administration; D037141:Mandatory Programs / Q000191:economics* / Q000458:organization & administration; D008484:Medicaid / Q000191:economics* / Q000458:organization & administration; D017059:Models, Econometric; D014481:United States