HCB and Group Homes
In 1981, the federal government established the home and community-based (HCB) program, which serves persons--children or adults--with physical or developmental disabilities, mental retardation, mental illness or the elderly. States can make HCB programs available to persons who are eligible for nursing facilities, ICFs/MR or hospitals under Medicaid; this provides a mechanism for qualified individuals to be cared for in their homes or at group homes in the community, while still receiving Medicaid payments. This “waiver” of Medicaid rules allow clients greater choice in living arrangements.
Like
ICFs/MR, HCB programs are optional benefits of a state’s Medicaid
program. States must apply to the federal government for a “waiver”
of certain statutory requirements of the Medicaid program to offer HCB
programs. When a waiver is granted a state may cover, at its discretion,
a wide variety of non-medical and social services and supports that allow
people to remain at home or in the community, including personal care,
homemaker assistance, care in alternative residential settings like group
homes, adult day care, adult foster care and other services. Again, states
have discretion in what services to offer. To determine eligibility, case
managers screen for Medicaid eligibility and identify the appropriate
level
of services and supports. They customize care plans based on the person’s
needs, preferences and availability of services.
An HCB program may provide these seven services:
- Case management
- Homemaker
- Home health aide services
- Personal care services
- Adult day care
- Habilitation
- Respite care
State governments may offer other, non- medical services, such as transportation, in-home support services, special communication services, minor home modifications and adult day care subject to approval. Medicaid does not pay for room and board.
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