Opinion ID: 2102120
Heading Depth: 1
Heading Rank: 1

Heading: The Home Care Program: The Federal Scheme

Text: Title XIX of the Social Security Act (42 USC § 1396 et seq. ), popularly referred to as the Medicaid Act, authorizes grants to States to provide medical and rehabilitative assistance to the poor, elderly and disabled. The purposes of the statute are to provide a supplementary health benefits program, to establish an expanded program of medical assistance and to increase benefits to those who qualify for assistance (S Rep No. 89-404, at 1 [1965], reprinted in 1965 US Code Cong & Admin News 1943). The Omnibus Budget Reconciliation Act of 1990 (OBRA 1990, Pub L 101-508 § 4721) amended the Medicaid Act to include personal care services as part of the home health services benefits authorized by this statute. According to Federal regulations, personal care services are (1) authorized by a physician in accordance with the recipient's plan of treatment; (2) provided by an individual who is qualified to provide the services and not a member of the recipient's family; and (3) furnished in a home, and, at the State's option, in another location (42 CFR 440.167). These services primarily involve hands on assistance with physical dependency needs such as bathing, dressing and taking medications ( see, Medicare & Medicaid Guide [CCH] ¶ 45,624, at 55,279). The Act authorizes the States to implement plans for medical assistance which include reasonable standards    for determining eligibility for and the extent of medical assistance under the plan which    are consistent with the objectives of [the Act] (42 USC § 1396a [a] [17]). Thus the statute confers broad discretion on participating States to determine the extent of services provided; the State standards need only be reasonable and consistent with the objectives of the Act.