The Community Alternatives to Psychiatric Residential Treatment Facilities Demonstration Grant Program (PRTF) provides up to $218 million to up to 10 states to develop 5-year demonstration programs that provide home and community-based services to children as alternatives to PRTF's.

These projects are designed to test the cost-effectiveness of providing services in a child’s home or community rather than in a PRTF and whether the services improve or maintain the child’s functioning.

There are nine state grantees that have provided services to 3,000 children as of October 2010. It is anticipated that over 6,000 children will receive services as of September 30, 2012. See the PRTF Implementation Status Reports from 2010 and 2008.

Eligibility

Must meet PRTF level of care which is a residential inpatient level of care as the Demonstration waiver must meet the same statutory guidelines as a 1915 (c) Waiver.

Approval Period

Grants are given for five years, from FY2006-FY 2011. Funds awarded in September 2011 will be available for providing services through September 30, 2012.

Evaluation

The Demonstration sough to answer the two questions below. It has easily met cost neutrality tests and on average has consistently maintained or improved functional status for all children and youth.

1. What is the effectiveness of the Demonstration in maintaining or improving a child’s functional level in home and community-based services verses the institutional service level of care in a PRTF?
   There is a positive effect of either maintaining or improving children’s functional outcome in juvenile justice, school functioning, substance abuse, and involvement with child protective services.
2. Do treatment costs, on average, total no more than anticipated aggregate PRTF expenditures in the absence of the Demonstration?
   Based on Waiver years one and two, there is strong evidence that the Demonstration costs substantially less than the institutional alternatives. In most cases, waiver costs were around 20 percent of the average per capita total Medicaid costs for services in institutions, an average per capita saving of $20,000 to $40,000

To view the Home and Community-Based Alternatives Final Evaluation Report, click here

To view the Home and Community-Based Alternatives Interim Evaluation Report, click here

To view the Home and Community-Based Alternatives Implementation Status report for 2008, click here 

To view the Home and Community-Based Alternatives Implementation Status report for 2009, click here