Services must be related to the management of the patient s terminal illness, symptom control, or the maintenance of activities of daily living and basic functional skills. States may request waivers of certain Federal requirements in order to develop Medicaid financed community-based treatment alternatives. With the approval of HCFA, states create their own package of HCBS for persons who would otherwise be in an institution without these services. All states have waiver programs for the elderly, but the services included vary by each state. Medicaid is a major resource for providing persons who are poor and who have disabilities access to services in both the private and public sectors.
States have the option of offering minimal or no optional benefits.
Thus, Medicaid beneficiaries who need certain services may not have access to them if their State does not cover these services. The Olmstead decision may lead to greater access to community-based services under Medicaid. The Medicaid program, in general, sets rates lower than those paid by commercial and other third-party insurers. Medicaid payments may not reflect the cost of caring for the behavioral and mental health problems that occur in nursing homes. Furthermore, states determine the payment rates for providers.