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88 UNDERSTANDING MEDICAID HOME AND COMMUNITY SERVICES: A PRIMERdisadvantages of each option in obtaining Federalfinancial participation (FFP).Targeted Case Management ServicesA state may claim FFP for case management servicesunder its Medicaid plan by offering them to adefined group of recipients, or to multiple groupsas long as different provisions apply to each. Forexample, a state may offer one form of targetedcase management services to recipients who havea mental illness and another to persons who areelderly and have physical impairments. The scopeof targeted case management services that may beclaimed for FFP can include: (a) conductingassessments, (b) assisting individuals and familiesto identify needed services and supports (whetherthe direct services are funded through theMedicaid program or otherwise), and (c) helpingthem obtain such services. (The State MedicaidManual contains a thorough discussion of theseactivities.)Advantages to states of offering targetedcase management services:• The state is free to define the population thatwill be targeted.• These services may be offered to Medicaid eligiblepersons regardless of whether the personparticipates in an HCBS waiver program.Consequently, they may be made availablewithout regard to type or funding source to allMedicaid-eligible individuals (includingHCBS waiver participants) who need homeand community services. This makes targetedcase management a potentially very usefulcoverage option in establishing a broad-basedcoordinated service system.• A problem for case management coveredunder an HCBS waiver program is that FFP isonly available once the person has entered theprogram. Thus, case management costsincurred in advance of enrollment are not eligiblefor FFP. (Some pre-waiver case managementcosts may be covered if they are begunbefore waiver participation but completed onthe first day the person is enrolled in the waiverprogram. See Appendix II for a recentHCFA letter to State Medicaid Directorsregarding the earliest date of service for whichFFP can be claimed.) Targeted case managementservices may be furnished irrespective ofwhether the person is enrolled in an HCBSwaiver program, however, enabling most preenrollmentcosts associated with service coordinationto be recouped.• Once states were severely limited in obtainingFFP for targeted case management servicesfurnished to institutionalized persons. Untilrecently, FFP was available only for servicesfurnished to individuals in the 30-day periodimmediately preceding the person’s dischargefrom the facility. Now, FFP is available for targetedcase management services to assist andarrange for an individual’s community transitionfor up to 180 days preceding discharge.This recent policy clarification by HCFAenables a state to involve community servicecoordinators earlier in the community placementprocess. FFP for such targeted case managementservices is available regardless ofwhether the person is enrolled upon dischargein an HCBS waiver program, receives otherMedicaid home and community services, or issupported through alternative fundingsources. However, FFP is not available if theperson’s community placement does not takeplace. 4• The costs of targeted case management servicesmay be claimed at the service rate, which inmany states is significantly higher than the 50percent rate that applies to administrativeclaiming (see below). 5• The targeted case management option is compatiblewith state strategies to delegate provisionof service coordination through contractsor memoranda of agreement with public ornon-public agencies (or multiple sources).This is beneficial where counties are responsiblefor the provision of case management services.Such strategies can be useful in promotingconsumer choice in selecting support coordinatorsfrom a variety of sources.• When the targeted groups are those with seriousmental illness or mental retardation and