Following a campaign promise made by the new administration to expand home- and community-based services (HCBS) as part of a far-reaching caregiver support plan, a group of U.S. senators sent a letter advocating for the expansion of HCBS. The recent passage of the American Rescue Plan (ARP) Act provides new provisions for HCBS, but advocates still hope for greater change. Here, we provide the latest funding updates and discuss potential next steps for HCBS expansion.
Advocacy Following The Election
In the leadup to the 2020 election, Biden introduced a plan to support caregivers and improve community-based services. The goal of the proposal was to ensure that any individual with a disability on an HCBS waiting list could access necessary services. In conjunction, federal support would be directed to states to cover the full costs of HCBS.
Following the election, 31 Democratic senators sent a letter to President Biden and Vice President Harris advocating for legislation that would expand community-based care options for people with disabilities and the elderly. The letter requested an investment of $450 billion into Medicaid, specifically for the purpose of HCBS expansion, which paralleled the amount laid out in Biden’s campaign-based proposal. The senators argued this amount would address several vital needs:
- Improve the nation’s caregiving system and adequately meet the needs of America’s increasing elderly population;
- Boost the economy by enhancing employment opportunities for caregivers and increasing opportunities to participate in the community for individuals with disabilities;
- Increase the wages of caregivers to a sustainable living wage, which would also benefit families and advance racial and social justice efforts; and
- Support people with disabilities, the elderly, and family caregivers by providing reliable resources for home- or community-based care.
HCBS In The ARP
In response to the administration’s proposed plan and the ongoing stressors of the COVID-19 pandemic, Congress passed the American Rescue Plan of 2021 (ARP) on March 10, 2021. Among the items included in the $1.9 trillion legislative relief package is funding for HCBS.
In the ARP, HCBS expansion is accomplished by increasing the Medicaid federal medical assistance percentage (FMAP) from April 1, 2021 to March 20, 2022 by a total of 10 percentage points. This boost is meant to supplement existing Medicaid funding, and states may only use the FMAP increase for HCBS. Covered services include home-delivered meals, supported employment, and day services, among others.
Next Steps
As the push for expanded and permanent HCBS solutions for the elderly and people with disabilities continues, not everyone agrees on the best way to make that happen. Key issues that continue to be most prevalent for providers and advocacy groups include:
- Seeking increased federal investment in Medicaid in order to support HCBS for everyone who wishes to live in and receive healthcare support in their communities;
- Allocating more money toward HCBS staffing, which would require federal support for increasing wages.
- Compensating family caregivers and providing intentional and integrated support to those care partners; and
- Establishing the Program of All-inclusive Care for the Elderly (PACE) as a mandatory benefit.
Consumers continue to demand integrated services with highly-trained staff, transparent spending, and accountability structures that serve patients and their families, further strengthening the push for HCBS expansion and permanent funding.