Medicaid Funding

The program, knows as Medicaid, became law in 1965 as a jointly funded cooperative venture between the Federal and State governments to assist states in the provision of adequate medical care to eligible needy persons. Medicaid is the largest program providing medical and health-related services to America’s poorest people.The Federal statute identifies over 25 different eligibility categories for which federal funds are available.The statutory categories can be classified in to five broad coverage groups: Children, Pregnant Women; Adults in Families with Dependent children; individuals with disabilities, and individuals 65 and over.

Within broad national guidelines which the Federal government provides, each of the states: establishes its own eligibility standards; determines the type, amount, duration, and scope of services; sets the rate of payment for services; and administers its own program. Thus, the Medicaid varies considerably from state to state.

Federal Medicaid regulations require states to provide services contained in the state plan to all populations who have a “medical necessity” for such service. There are no provisions for a state to restrict services by populations, numbers of clients or dollars. With institutional care being the largest Medicaid expenditure, Congress granted states the ability to apply for Home and Community Based Services waivers to offer a less costly alternative to the elderly and adults and children with disabilities or complex medical conditions.Under “waivers” states can determine the number of people they service, the populations (elderly, DD, etc.), the services to be offered, and the area of the state to be covered.

Nebraska DHHS at the mandate of the NE Legislature developed an Aged and Disabled Medicaid waiver to serve elderly, and adults and children with disabilities who otherwise would require nursing home care (1988).This allowed clients options in meeting their needs in independent living and community services and gave DHHS federal Medicaid match to fund the needed services at a lower cost than nursing home services.

Nebraska was approved by HCFA (now CMS or Centers for Medicare and Medicaid Services) to offer assisted living as a waiver service in July, 1998.The service has grown from 28 waiver-certified providers in 1998 to a current number of 207. The number of persons authorized for assisted living with waiver has increased from 156 in 1998 to 1600 in 2004.

Assisted Living is an array of support services that promote client self-direction and participation in decisions that incorporate respect, independence, individuality, privacy, and dignity in a home environment. These services include assistance with or provision of personal care activities, activities of daily living, instrumental activities of daily living, and health maintenance.