Martin Kitchener, PhD, MBA, Department of Social & Behavioral Sciences, University of California San Francisco, 3333 California St, Suite 455, San Francisco, CA 94143-0612, 415-502-7364, martink@itsa.ucsf.edu, Terence Ng, MA, Dept of Social and Behavioral Sciences, University of California San Francisco, 3333 California Ave, Suite 455, San Francisco, CA 94118, and Charlene Harrington, PhD, Disability Statistics Center, Institute for Health & Aging, University of California, San Francisco, 3333 California Street, Room 340, San Francisco, CA 94118.

During the 1990s, in response to growing consumer demand and the Olmstead decision, states unevenly extended Medicaid home and community-based (HCBS) programs including two personal care programs for the disabled: (1) personal care state plan optional benefits and (2) personal care provided within certain 1915 (c) HCBS waivers. As the U.S. economy slipped into recession in 2002, 43 states reported budget gaps between declining revenue and increased Medicaid spending. As the states search for new ways to control Medicaid LTC costs, development of Medicaid personal care for the disabled is threatened. This paper presents the latest available trend data on participants and expenditures for Medicaid state plan personal care and personal care provided within waivers from surveys of all states from 1999 through 2002, and the findings from a national survey of cost control polices on each program in 2002. Data for 2002 indicate that the growth rates in participants and expenditures are generally flat and are slowing in some states. The 2002 policy survey data also report how states are changing benefit, financial eligibility, and need policies to slow growth in personal care programs. The trends in Medicaid personal care expenditures are compared with CMS Form 64 data concerning Medicaid nursing home expenditures over the same period.

Learning Objectives: From this session participants will be able to

(
• identify latest trends in the Medicaid personal care disabled participants and expenditures, (
• compare these with trends in Medicaid nursing home spending, (
• understand state responses to fiscal crises in terms of Medicaid policy changes for personal care, and (
• consider the potential impact on access to Medicaid personal care for the disabled.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.