Toward Holistic Health Services under Medicaid
As an optional benefit under Medicaid, Home and Community-Based Services are at risk of deep cuts as federal Medicaid funding is reduced. Just last week, federal legislative proposals were reintroduced to ensure comprehensive HCBS coverage under Medicaid, along with the adequate workforce funding needed to sustain it. The HCBS Access Act and Long-Term Care Workforce Support Act would work together to ensure that disabled people and elderly adults are able to access community living across the lifespan. Justice in Aging has a fact sheet on how this legislation would realize the promise of the Olmstead Supreme Court decision.
Further underfunding of HCBS on the horizon would force more people into institutional settings like nursing homes, which are covered under Medicaid. The HCBS Access Act would require state Medicaid programs to convert HCBS into a required benefit alongside institutional care, which would ultimately cost less than the institutional options currently available. The bill would ensure federal funding for the HCBS program for a minimum of 10 years to support this programmatic mandate. Once HCBS becomes a required benefit under Medicaid, the need for complex waiver programs would be eliminated, supporting more streamlined care delivery and enrollment for people who need home care. Waiting lists and caps on enrollment would also be removed.
The ongoing effort to empower self-direction of services by disabled Medicaid recipients would be strengthened. Under this law, self-direction would be a required option across all states. This legislation is being considered as a way to undo some of the funding cuts from HR 1. In the meantime, you can share resources from the Autistic Self-Advocacy Network with your HCBS enrollees for plain language overviews of existing programs and supports.
Medicaid is a critical program for meeting the needs of many different people across the disability community, who access a variety of services. With full HCBS funding, states wouldn’t have to make hard decisions to cut other programs that support independent living for disabled people, like mental health care. Mental health care has seen an increase in Medicaid usage, tracked through higher reimbursement over the last five years, thanks to reporting from Health Affairs. Stay tuned for further resources to support the HCBS Access Act in the weeks ahead.
Last week, we highlighted a series of blog posts from the Georgetown University Center on Health Insurance Reforms (CHIR) where they analyzed the comments that were made by various stakeholder groups on the Notice of Benefit and Payment Parameters. Last week, we highlighted three blog posts from CHIR and this week, they posted the final blog in the series, focusing on comments from provider groups.
Archives of our weekly updates are available on the NDNRC website. Follow AAHD’s other newsletters to stay current on research opportunities and policy developments supporting people with disabilities. This newsletter is supported by the American Association on Health and Disability (AAHD). Sign up to become an AAHD member today to support ongoing projects like this.