Millions of Americans rely on home and community-based services (HCBS) for critical supports that allow them to live comfortably in their own homes and communities as they age or manage disabilities or chronic conditions.
Medicaid is the primary source of coverage for HCBS, helping older adults and Americans with disabilities, including children with complex medical conditions, access healthcare services in their home and familiar settings and providing support for caregivers and family members.
A recent memorandum from the U.S. Department of Justice argues that federal law does not impose an “integration mandate” on states, meaning that the federal government will not enforce the integration of people with disabilities into their communities. As a result, some states may opt to cut HCBS and return to the outdated practice of placing people in nursing homes or institutional settings.
State leaders have already started to push back on this guidance. Earlier this month, a group of 18 governors called on the federal government to preserve longstanding protections that help people with disabilities receive care and services in community settings.
Against this backdrop, here’s what you need to know about HCBS and why it’s critical to protect these services for patients across the country.
Medicaid plays a major role in supporting care for older adults and people with disabilities.
- Medicaid provides coverage to one in three people with disabilities. The program is a major source of coverage for individuals with complex health needs: nearly 60% of Medicaid enrollees who qualify based on a disability have two or more health challenges, such as difficulty with memory, living independently or self-care.
- Medicaid covers over 7 million low-income seniors who are also enrolled in Medicare and provides many of these individuals with additional services not traditionally covered by Medicare, including HCBS.
HCBS offer a more affordable, comfortable and personalized option for long-term care.
- Medicaid programs cover long-term services and supports (LTSS), a broad term for supportive services that help people with their activities of daily living (ADL), including toileting, bathing, dressing and eating meals.
- While state Medicaid programs are required to provide these services in nursing facilities, states also may elect to provide these services in people’s homes and community settings, also known as HCBS.
- These are long-term, non-medical supportive personal care services that enable people to remain in their communities.
- HCBS provide support to various patient groups, including older adults and individuals with intellectual/developmental disabilities, physical disabilities, mental illnesses or substance use disorders.
Medicaid is the nation’s predominant source of coverage for HCBS – advancing better health outcomes while reducing costs.
- Nearly 6 million Americans rely on Medicaid HCBS for needed care and support.
- HCBS are often not covered by other forms of insurance, making Medicaid the only meaningful option for coverage for some populations, including those who are most vulnerable or medically complex.
- This Medicaid benefit has become increasingly important as there is a growing preference among Americans to receive care at home.
- Decades of research shows that access to high-quality HCBS is associated with better health outcomes, including fewer hospitalizations and emergency department visits, ultimately resulting in decreased healthcare spending. These services have also proven to reduce long-term healthcare costs over time.
Federal policy guidance threatens access to HCBS and jeopardizes critical care for people with disabilities and complex medical needs.
- The recent federal government memorandum sends a message to states that they will no longer be expected to fund HCBS. States may start to cut these services altogether and return to institutionalization, threatening decades of progress ensuring individuals with disabilities can remain in the comfort of their own homes and communities.
- Recent reductions in funding for state Medicaid programs under OBBBA are likely to further incentivize states to cut optional benefits like HCBS as they look for ways to reduce Medicaid spending.
The Modern Medicaid Alliance urges federal policymakers to support a strong Medicaid program that ensures people with disabilities and individuals with complex medical needs – and the families and caregivers who support them – have access to the care and services they need.