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Home and Community Based Feasibility Analysis: Medstat Report
April 5, 2006

In July 2005 the Pennsylvania Department of Public Welfare contracted with Thomson Medstat to evaluate long-term living programs in the state, with a special emphasis on the current structure of the Medicaid Home and Community Based Services (HCBS) waiver programs. Home and Community Based Services Reform and Rebalancing Feasibility Analysis was released last month. The report offers recommendations regarding the future development of this system.

The demographics of the state are fairly unique in that they are driving a high level of demand for publicly financed long-term care services. The state’s population of those over age 65 is the second highest in the nation.

Since the late 1990s Pennsylvania has made significant investments in expanding HCBS options and the waiver programs use for persons with mental retardation is currently above the national average. However, HCBS expenditures are below average for older adults and people with physical disabilities.

The state is also unique in the number of HCBS wavier programs it currently administers. Medicaid supports are provided through 11 waivers that serve a variety of populations, The waivers are administered by four separate state agencies. The national average for waivers is 5.7 per state. Pennsylvania waivers include:

  • Office of Mental Retardation: Consolidated waiver and Person/Family Directed Support waiver;
  • Office of Child Development: Infants, Toddlers, and Family Waiver;
  • Department of Aging: Aging waiver; and
  • Office of Long Term Living: OBRA, COMMCARE, Independence, Attendant Care, Elwyn, Michael Dallas, and AIDS waivers.

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