Medicaid Managed Care - U.S. Senate Special Committee on Aging

446
Appendix H
<strong>Medicaid</strong> Waiver Program Services Offered
for Persons With Developmental Disabilities
in Florida, Michigan, and Rhode Island
States, with HCFA'S approval, choose which services they offer through
waiver programs and how the services are defined. States can choose from
a list of standard services and definitions in the HCFA waiver application or
design their own services. In designing their own services, states can add
new services or redefine standard services. States can also extend optional
services to offer more units of these services to waiver program recipients
than are available to other recipients under the regular <strong>Medicaid</strong> program.
The three states we visited chose to offer a number of standard services
under their waiver programn Each state also modified the definition of
some standard services that it provides or offered services not on the
standard waiver list. (See fig 1. 1.) For example, Florida modified the
definition of case management to include helping individuals and families
identify preferences for services. Florida also added several nonstandard,
state-defined services such as behavior analysis and assessments and
supported living coaching. Rhode Island's modified definition of
homemaker services includes a bundle of services often offered
separately, including standard homemaker services, personal care
services, and licensed practical nursing services. Rhode Island also added
nonstandard services to provide minor assistive devices and support of
family living arrangements. Michigan modified the standard definition of
environmental accessibility adaptations to include not only physical
adaptations to the home, but to the work environment as welL Michigan
also recently added a new state-defined service, community living
supports, which is a consolidation of four services-in-home habilitation,
enhanced personal care, personal assistance, and transportationpreviously
provided separately. Florida and Michigan also chose to offer
several optional services in their waiver programn
P.& *5 GAO/HER546-120 Wh- FV- f- D-Wp-tft Dk-W"