Aging in Place in Your State: Arkansas
Photo of Fayetteville house by astroguy52 from Pixabay
Arkansas is a state of contradictions.
While most people consider it a southern state—it’s nestled between Texas, Oklahoma, Missouri, and Tennessee, with Louisiana just to the south—Arkansas occupies a somewhat ambiguous position. The state was not among the first to secede from the Union before the Civil War, and although it eventually was part of the Confederacy and supplied dozens of infantry regiments and artillery to the southern effort, it also supplied troops and artillery batteries to the Union cause, including regiments of “U.S. Colored Troops”.
Today, Arkansas is America’s number-one rice producer, largely due to annual rainfalls that, in some places, surpass that of Seattle, but “The Natural State” is also famously woodsy, with more than half of its total area forested with an estimated 11.9 billion trees. And while Arkansas is the home of that icon of affordable retail, Walmart—the world’s largest company by revenue—it also hosts the headquarters of upmarket department store Dillard’s.
Southern and midwestern, cultivated and wild, downmarket and upscale: there’s a definite duality to Arkansas. And when it comes to services that help people “age in place” at home, that duality occurs again, with more traditional services existing alongside self-directed delivery models and other, more unusual offerings.
Arkansas’ two main programs that provide home modification benefits for aging Arkansans are the ARChoices program, a state Medicaid waiver service, and the Independent Choices program, which is run by the state but is not a waiver service. The state also provides for folks who want to move out of a traditional assisted living or nursing home.
The ARChoices program, the state’s Medicaid waiver program, provides “home and community-based care for individuals aged 21 and over as an alternative to institutionalization,” according to the Arkansas Department of Human Services. People who qualify for this program are either age 65 and over or age 21 to 64 with a physical disability (as determined by SSA/SSI criteria), and they must be legal residents of Arkansas who require an “intermediate” level of care. They also must be eligible to receive federal Medicaid services, with the attendant income and asset restrictions that implies. For example, a single applicant must have income no greater than 300% of the SSI Federal Benefit Rate, which currently works out to about $2,500 a month. Single applicants also must not hold assets greater in value than $2,000, but the formula doesn’t count assets like a primary home and its contents, certain personal possessions, pre-paid burial plots, and the like. Spouses of an applicant can sometimes hold greater assets without hurting the applicant’s chances of qualifying for benefits.
Beneficiaries of the ARChoices program receive services like attendant care, home-delivered meals, adult day services and health services, respite care (both in-home and in facilities), a personal emergency response system, and environmental modifications, which the state defines as “changes to your home that will help you get around more easily and safely, like grab bars or a wheelchair ramp.” ARChoices operates under a “self-direction model,” meaning that recipients of services are responsible for hiring, training, and supervising the people who provide services to them, and they help determine how the Medicaid funds budgeted for them are spent. Although there is more responsibility associated with self-directed care, recipients can get help—with everything from hiring, payroll, and scheduling to purchasing, tracking financials, and monitoring expenses—from a financial services vendor associated with the ARChoices program.
Arkansas also participates in a “Money Follows the Person” program, which helps Medicaid-eligible people (seniors and people with physical and developmental disabilities or mental illnesses) who currently live in long-term care facilities transition back to community living and receive home and community-based services (HCBS). Applicants for these services must be Medicaid-eligible and be residents of a long-term care facility for at least the past 60 days. Successful applicants will work with an Intense Transition Manager, who will help them plan their transition to community living, including deciding where to live. The program also pays for rental and utility deposits, one-time setup costs for new apartments, and home modifications that boost independent living.
The state’s other major service that provides home modification benefits is the IndependentChoices program, which is based on the Cash and Counseling model. The program started in the late 1990s as as part of a three-state “demonstration program,” run by the University of Maryland and with funding from the Robert Wood Johnson Foundation, to see how such programs would work. Due to positive feedback from both states and program participants who receive services through about 2009, almost every state now has some type of program that generally follows the Cash and Counseling model, although other states may call it self-directed care, consumer-directed care, participant direction, and the like.
Arkansans who qualify for the program—generally, they must be eligible to receive Medicaid services, although Arkansas’ requirements are more strict—receive both a cash stipend to spend on their personal care and some counseling and help with deciding how to spend it. Although most program members spend the money on hiring personal care attendants (often family members) to help them with various daily living activities, other participants have used some or part of their monthly stipend to buy or install home improvements, appliances, or other equipment that helps them continue to live independently. Studies of programs like Arkansas’ have shown that participants experienced a reduction in unmet needs, an increase in positive health outcomes and reported quality of life, and a savings in money to the state and the Medicaid program.
