Realizing the Vision of Medicaid-funded HCBS: A Framework for Enhancing Access and Advancing Quality in HCBS Provision in Managed Medicaid LTSS

DATE: September 5, 2021

Published by The National MLTSS Health Plan Association

The COVID pandemic forced the nation to confront a harsh reality with respect to the consequences of various gaps in our long-term care system supporting older adults with complex medical needs and individuals with disabilities. The pandemic shed light on the need for more integrated, individualized home and community-based services (HCBS) options to assure that people can live, work, and thrive in the greater community based on their own individual preferences, interests, and needs. 

Recognizing the critical importance of strengthening the HCBS delivery system as one component of federal infrastructure modernization efforts as well as in meeting the growing demand of the nation’s care economy, the federal government has moved forward with proposals to stimulate significant funding and policy changes in 2021. If implemented, these forwardthinking investments and policy reforms could revolutionize the provision of HCBS in America and assure that all aging adults and individuals with disabilities get the individualized care they need to age in place in their own homes, fully participating in the greater community through work, recreation, social
relationships, and civic engagement.

Recent Federal Response to Recognition for Increased Access to Higher-Quality HCBS Options 

The American Rescue Plan Act of 2021 (ARP) provided short-term enhanced funding for States to access for the purposes of expanding or enhancing Medicaid-funded HCBS. The increased funding is intended to “assist States in leveraging federal resources to increase health equity in Medicaid beneficiaries’ access to HCBS, positive health outcomes, and community integration” (CMS Press Release, 5-13-2021). Specifically, Section 9817 of the ARP provides States with a temporary 10 percentage point increase to the federal medical assistance percentage (FMAP) for certain Medicaid HCBS from April 1, 2021, through March 31, 2022, to improve HCBS under the Medicaid program. States then have until March 31, 2024, to continue to spend down any increased funding received because of the enhanced FMAP. The additional federal funding made available under the ARP allows States to tailor HCBS enhancements based on the needs and priorities of its residents, while protecting and strengthening the HCBS workforce, safeguarding financial stability for HCBS providers, and accelerating long-term services and supports reform and innovation. 

On the heels of the ARP, Congress has introduced several legislative proposals that would significantly expand the capacity of state Medicaid programs to provide increased HCBS, and, for the first time, erase the institutional bias that persists in Medicaid-funded LTSS. The Better Care, Better Jobs Act1 , as well as the HCBS Access Act2 , are legislative proposals that both seek to create a mandatory Medicaid-funded HCBS option for all eligible individuals with disabilities and aging adults, thus eliminating waiting lists and increase access to HCBS across the country. The funding attached to these reform investments is substantial – as much as $400 billion in new money could be authorized by late 2021 to support capacity building efforts within state Medicaid HCBS systems to enact the ambitious aims of these legislative proposals. 

As these efforts continue to roll out, it is imperative that the national dialogue around HCBS modernization begin to bridge the gap in both access to and quality of HCBS.

The information above appears on a report published by The National MLTSS Health Plan Association. Click here to read the full report.