The Aid and Attendance program and the Homebound program of the U.S. Department of Veterans Affairs allow veterans to receive a cash benefit to pay for personal care and other assistive services, including housekeeping and shopping (Rosenkranz, 2005). For a single veteran, the maximum yearly payment for the aid and attendance benefit in 2006 was approximately $18,200 (VA, 2006c).

As one of five primary goals, the Social Services Block Grant program (Title XX of the Social Security Act) funds services to prevent inappropriate institutionalization by supporting community- or home-based care (total spending on the program was limited to $1.7 billion in 2003) (U.S. House of Representatives, Committee on Ways and Means, 2003).

Title III of the Older American’s Act funds assistance to people age 60 or over whose incomes exceed the income limits that allow them to qualify for Medicaid. Federal spending on personal care services under this legislation is quite small: $13 million in 2002, plus $33 million for chores and homemaker services and $193,000 for home delivery of meals (Kassner, 2004).

CMS provides infrastructure grants to states to help establish personal care programs and train workers (CMS, 2005g).

The Office of Civil Rights in the U.S. Department of Health and Human Services has investigated and intervened in cases involving complaints about a lack of access to community-based services that would prevent or allow an individual to transfer from institutional care to home. Some cases were resolved when states agreed to cover personal care services (DHHS, 2006a).

In 2001, as part of the New Freedom Initiative, Executive Order 13217 (Community-Based Alternatives for Individuals with Disabilities) directed six federal agencies to evaluate their policies and programs to determine how they might better support states in implementing the Olmstead v. L.C. decision. One area to be evaluated was personal assistance and direct care services (DHHS, 2001).