The Politics of Autism includes an extensive discussion of insurance and Medicaid services for adults with intellectual and developmental disabilities. Home and Community-Based Services (HCBS) are particularly important.
The COVID-19 pandemic presented a public health emergency that was unprecedented in its scope and duration and brought new focus to the long-standing unmet need for home and community-based services (HCBS) among seniors and people with disabilities and direct care workforce shortages. Recognizing Medicaid’s role as the primary payer for HCBS, this issue brief presents early findings from the most recent KFF 50-state survey of Medicaid HCBS programs. It focuses on state policies adopted in response to challenges posed by the pandemic, the pandemic’s impact on Medicaid HCBS enrollees and providers, and states’ early plans for the new American Rescue Plan Act (ARPA) 10 percentage point temporary increase in federal Medicaid matching funds for HCBS. We survey states about HCBS provided through state plan authorities and waivers. There were 277 HCBS waivers in FY 2018. Overall, 41 states responded to the survey by mid-July 2021, accounting for 87% of total HCBS spending nationally in FY 2018, though response rates for specific questions varied. We highlight some specific state examples where states provided additional information with their responses. Key finding include the following:
- Important data gaps remain, with just under half of responding states tracking COVID-19 vaccination rates among Medicaid HCBS enrollees. At the same time, state HCBS programs are playing a role in facilitating vaccine access for HCBS enrollees, with most responding states adopting multiple policies in this area. Over one-third of responding states have publicly available data on COVID-19 cases and deaths among HCBS enrollees.
- The Medicaid HCBS provider infrastructure declined during the pandemic, with two-thirds of responding states reporting a permanent closure of at least one provider. Most of these states reported permanent closures among more than one HCBS provider type. States most frequently cited workforce shortages as the pandemic’s primary impact on in-home and group home services, while closures due to social distancing measures was the most frequently reported primary impact on adult day health and supported employment programs.
