This research was supported by Health Care Financing Administration Contract No. 500-96-0005. In this contract, the Urban Institute is a subcontractor to the Lewin Group. The opinions expressed in the report are those of the authors and do not necessarily reflect the position of the Health Care Financing Administration or the Urban Institute.

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Table of Contents

Introduction

The Long-Term Care System in Maryland

Programs and Administrative Structure

Eligibility Criteria and Assessment

Case Management and Service Planning

Services

Consumer Direction

Cost Containment

Quality Assurance

Federalism Issues

Issues for the Future

Introduction

Maryland, a fairly small mid-Atlantic state with about 5 million people in 1999,¹ has 12 home and community services programs for older persons and adults with physical disabilities. Maryland’s Medicaid program provided home and community services to approximately 5,100 beneficiaries through the optional personal care benefit and 4,600 beneficiaries through its optional medical day care program in fiscal year 1999. The state has one currently operating Medicaid waiver for older adults with 135 slots, which will be expanded to 1,135 slots in 2001. The state will implement another waiver in 2001 with 150 slots in the first year for non-elderly adults with physical disabilities. The state also has eight small, state-funded home and community services programs designed to serve adults who are not eligible for Medicaid. The state has a complex administrative structure for its home and community services programs, with several state and local agencies involved.

Maryland’s home and community services programs have grown over the years. The state’s new Medicaid waiver and the recently expanded waiver will result in increased coverage for community services. Maryland has some innovative programs, including a Program of All-Inclusive Care for the Elderly (PACE) site.

This paper addresses the home and community services system for older people and younger adults with physical disabilities in Maryland, focusing on the state administrative structure, eligibility and assessment, services covered by Medicaid and other programs, cost containment, and quality assurance. This report also summarizes government officials’ and key stakeholders’ opinions about how well the Medicaid and state-funded programs serving the aged and disabled work.

Information was obtained from public documents, state of Maryland web sites, and interviews with state officials, consumer representatives, and provider associations. Interviews were conducted in person in Washington, DC and Baltimore, Maryland, in February and March 2000, respectively. One telephone interview was conducted in February 2000. Questions were asked using a structured, open-ended interview protocol. To encourage candor in their answers, respondents were told that they would not be quoted by name or identified by type of respondent within a state (e.g. home health industry representative in Maryland).

Notes

1. www.census.gov.

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Disclaimer: The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.