In-Home Services for the Elderly

Cost Sharing Expands Range of Services Provided and Population Served Gao ID: HRD-90-19 October 23, 1989

Pursuant to a congressional request, GAO examined existing state approaches to cost-sharing for in-home services for the elderly, focusing on the: (1) extent to which cost-sharing was currently used; (2) types of services that states cost-shared; (3) benefits and disadvantages of cost-sharing; (4) types of fee schedules used; and (5) characteristics of clients participating in cost-sharing programs.

GAO found that: (1) 36 states and about one-third of the area agencies surveyed used cost-sharing for in-home services to some extent for such services as adult day care and home health and personal care services; (2) most of the state and area agencies surveyed supported cost-sharing because it allowed them to serve more low-income people, reduce the welfare stigma associated with receiving free services, improve service equity, and reduce service cutbacks; (3) both the cost-sharing and non-cost-sharing agencies favored amending legislation to permit cost-sharing for selected services; (4) most agencies used self-reported client income to determine fees for the services; (5) although arguments against cost-sharing stated that income reporting would cause declines in low-income and minority elderly, many agencies that did not cost-share collected client income data; (6) the majority of clients paid no fees because their incomes were below the minimum charge level; (7) fee-paying clients in Rhode Island, Illinois, and Pennsylvania paid 20 percent or less of the service costs, and very few clients paid the full cost of services in the cost-sharing programs; (8) the typical client in the three programs reviewed was a low-income white older female, unmarried or living alone; and (9) there was no evidence that cost-sharing would result in shifting services toward higher-income elderly.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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