American Rescue Plan Strengthens Medicaid Home and Community-Based Services

Photo credit: Kristin Chalmers

Over the past weekend, the U.S. House of Representatives passed the American Rescue Plan, modeled after President Biden’s $1.9 trillion dollar COVID-19 relief plan. At the Center for Consumer Engagement in Health Innovation, we’re particularly excited that the bill increases funding and support for Medicaid Home and Community-Based Services (HCBS), a critical benefit for individuals with complex health needs, including individuals dually eligible for Medicare and Medicaid, and a particularly important benefit to sustain and strengthen during the pandemic. Specifically, the bill increases federal funding for state Medicaid HCBS programs for one year and requires states to spend this funding primarily on supporting the HCBS workforce, such as by increasing pay and benefits, providing personal protective equipment (PPE) and recruiting new HCBS providers. 

Medicaid HCBS is a subset of Medicaid long-term services and supports (LTSS), which are the long-term care services many older adults and individuals with disabilities need assistance with due to their age, functional limitation and/or health condition. For example, LTSS can include assistance with daily activities such as bathing, dressing and eating, as well as non-medical services such as transportation (and not just to medical appointments, but to social gatherings and religious services), medication administration and meal preparation. While some long-term care is provided in nursing homes and other types of institutional settings, home and community-based services, as the name suggests, are provided in someone’s home or in more community-based settings such as adult day health centers and assisted living facilities. Over time, Medicaid LTSS recipients have been increasingly receiving these services in their homes and communities. Although the Medicare program is intended for the populations who need LTSS, unfortunately it does not cover these critical services. State Medicaid programs, in contrast, are required by federal law to cover LTSS, but are not required to cover HCBS. While all states do offer HCBS, many also restrict eligibility through the use of waiting lists, and currently there are over 800,000 individuals on Medicaid HCBS waiting lists. 

Medicaid HCBS are critical for several reasons. First, the COVID-19 pandemic has highlighted and increased the need for home-based care, as more than one-third of the nation’s deaths from COVID-19 have been linked to nursing homes and other long-term care facilities. Second, most older adults would prefer to age in their home and community, and so increasing access to HCBS would go a long way towards making long-term care in Medicaid more-person centered. Lastly, because HCBS involves services such as non-medical transportation, home-delivered meals and home modifications such as shower “grab-bars” to make someone’s residence safer to live in, HCBS is an important way that the Medicaid program addresses the social determinants of health. While states have sprung into action during the pandemic to increase access to HCBS in several ways, more action is needed at the federal level to improve and strengthen HCBS across the country. 

By increasing federal funding for HCBS, the American Rescue Plan takes a significant step toward improving access to a critical benefit at a time when the populations it’s intended to serve need it most. In addition, by requiring states to use the funds to protect, strengthen and support the HCBS workforce during the pandemic, the HCBS provisions also take steps to address the racial disparities in COVID-19-related cases and deaths in the health care worker industry, an industry that was already long in need of more financial and infrastructural support. Therefore, to show our support for these provisions, Community Catalyst, FamiliesUSA and over 200 health advocacy organizations submitted a letter to the Senate in advance of their take up of the bill this week. We hope the Senate will maintain this language to help ensure older adults and individuals with disabilities can continue to receive the care they need in the setting they both need right now, and deserve in the long-term.