NAHC to Congress: Time for a Big Permanent Investment in HCBS

NAHC and a group of likeminded organizations have written to leaders of Congress, urging them to make a large permanent investment in home and community-based services (HCBS). The American Rescue Plan Act funding allowed states to provide hazard pay to the direct care workforce and maintain access to vital HCBS that have enabled people with disabilities and older adults to remain living safely in their own homes during the pandemic.

However, those rescue funds are temporary and have stopped accruing. Without a large permanent investment in HCBS, the direct care workforce crisis will worsen and HCBS access will decrease. Timely investment is needed to provide greater sustainability for states, individuals who rely on HCBS, their family caregivers, and the paid workforce providing these critical services.

While the House of Representatives passed a $150 billion investment in HCBS last year, the Senate has not yet done so. The Senate should pass the $150 billion HCBS investment as soon as possible. This investment is essential for building a sustainable HCBS infrastructure that can begin to address the magnitude of need in our communities. This investment will both increase access to Medicaid HCBS and create more high-quality direct care jobs to support the people who do this work as well as people with disabilities of all ages and their families. HCBS are also more cost effective for states and the federal government than institutional care, making this investment an all-around win for individuals, families, workers, and state and federal governments.

When older adults who want to age in place and people with disabilities who need support to work, live independently, and be a part of their communities are left waiting, the responsibility for care and support often falls on unpaid family caregivers, who also need financial assistance. Over 90% of people with disabilities and aging adults living in the community receive unpaid support. The workforce and earnings losses related to unpaid family caregiving are significant and well-documented. The costs of this inadequate system fall disproportionately on people of color with limited income and wealth. For example, family caregivers spend on average 26% of their annual income on caregiving expenses, but the share of income African American/Black and Hispanic/Latino family caregivers report spending is 34% and 47%, respectively.

To address the long-standing inequities the pandemic exposed and exacerbated, this investment is critical to fortify a workforce that must expand to meet a rapidly increasing level of need. The HCBS workforce provides vital services, and yet these workers–who are primarily women of color–have been devalued and underpaid for decades, leading to severe staff shortages that result in crucial gaps in service availability, lengthy waiting lists, service line closures, and additional obstacles to achieving a high quality of life for workers and recipients alike.

This investment is also necessary to help people who are in nursing facilities and other institutions return to the community. Many people are in institutions who do not need to be because persistent underfunding and bias have created an inadequate HCBS infrastructure to meet the demand. The HCBS legislation passed by the House would directly address this issue by making the widely successful Money Follows the Person program permanent. It would also help married individuals who rely on Medicaid to remain living at home with their spouse by permanently extending the federal spousal impoverishment protections to HCBS.

Investing in home-based care has strong bipartisan support. An April 2022 survey of over 1200 likely voters shows that affordable long-term care for seniors and people with disabilities is the most popular provision in the investment package with support from 87% of all respondents and 85% of Republicans. A survey last year of 1,400 voters age 50 and older found that 87% supported increasing resources for in-home care, including 82% of Republicans, and another survey of 800 people age 18 and older found that 89% of Americans support an increased public investment in affordable home care services.

NAHC to Congress: Time for a Big Permanent Investment in HCBS

NAHC and a group of likeminded organizations have written to leaders of Congress, urging them to make a large permanent investment in home and community-based services (HCBS). The American Rescue Plan Act funding allowed states to provide hazard pay to the direct care workforce and maintain access to vital HCBS that have enabled people with disabilities and older adults to remain living safely in their own homes during the pandemic.

However, those rescue funds are temporary and have stopped accruing. Without a large permanent investment in HCBS, the direct care workforce crisis will worsen and HCBS access will decrease. Timely investment is needed to provide greater sustainability for states, individuals who rely on HCBS, their family caregivers, and the paid workforce providing these critical services.

While the House of Representatives passed a $150 billion investment in HCBS last year, the Senate has not yet done so. The Senate should pass the $150 billion HCBS investment as soon as possible. This investment is essential for building a sustainable HCBS infrastructure that can begin to address the magnitude of need in our communities. This investment will both increase access to Medicaid HCBS and create more high-quality direct care jobs to support the people who do this work as well as people with disabilities of all ages and their families. HCBS are also more cost effective for states and the federal government than institutional care, making this investment an all-around win for individuals, families, workers, and state and federal governments.

When older adults who want to age in place and people with disabilities who need support to work, live independently, and be a part of their communities are left waiting, the responsibility for care and support often falls on unpaid family caregivers, who also need financial assistance. Over 90% of people with disabilities and aging adults living in the community receive unpaid support. The workforce and earnings losses related to unpaid family caregiving are significant and well-documented. The costs of this inadequate system fall disproportionately on people of color with limited income and wealth. For example, family caregivers spend on average 26% of their annual income on caregiving expenses, but the share of income African American/Black and Hispanic/Latino family caregivers report spending is 34% and 47%, respectively.

To address the long-standing inequities the pandemic exposed and exacerbated, this investment is critical to fortify a workforce that must expand to meet a rapidly increasing level of need. The HCBS workforce provides vital services, and yet these workers–who are primarily women of color–have been devalued and underpaid for decades, leading to severe staff shortages that result in crucial gaps in service availability, lengthy waiting lists, service line closures, and additional obstacles to achieving a high quality of life for workers and recipients alike.

This investment is also necessary to help people who are in nursing facilities and other institutions return to the community. Many people are in institutions who do not need to be because persistent underfunding and bias have created an inadequate HCBS infrastructure to meet the demand. The HCBS legislation passed by the House would directly address this issue by making the widely successful Money Follows the Person program permanent. It would also help married individuals who rely on Medicaid to remain living at home with their spouse by permanently extending the federal spousal impoverishment protections to HCBS.

Investing in home-based care has strong bipartisan support. An April 2022 survey of over 1200 likely voters shows that affordable long-term care for seniors and people with disabilities is the most popular provision in the investment package with support from 87% of all respondents and 85% of Republicans. A survey last year of 1,400 voters age 50 and older found that 87% supported increasing resources for in-home care, including 82% of Republicans, and another survey of 800 people age 18 and older found that 89% of Americans support an increased public investment in affordable home care services.

NAHC to Congress: Time for a Big Permanent Investment in HCBS

NAHC and a group of likeminded organizations have written to leaders of Congress, urging them to make a large permanent investment in home and community-based services (HCBS). The American Rescue Plan Act funding allowed states to provide hazard pay to the direct care workforce and maintain access to vital HCBS that have enabled people with disabilities…

HHS to Provide $110 Million in HCBS for Seniors & Disabled

Scroll down for more info on webinars for funding applicants The Centers for Medicare & Medicaid Services (CMS) announced it will offer more than $110 million to expand access to home and community-based services (HCBS) through Medicaid’s Money Follows the Person (MFP) program. First authorized in 2005, MFP has provided states with $4.06 billion to…

HHS to Provide $110 Million in HCBS for Seniors & Disabled

  • Scroll down for more info on webinars for funding applicants

The Centers for Medicare & Medicaid Services (CMS) announced it will offer more than $110 million to expand access to home and community-based services (HCBS) through Medicaid’s Money Follows the Person (MFP) program.

First authorized in 2005, MFP has provided states with $4.06 billion to support people who choose to transition out of institutions and back into their homes and communities. The new Notice of Funding Opportunity (NOFO) makes individual awards of up to $5 million available for more than 20 states and territories not currently participating in MFP. These funds will support initial planning and implementation to get the state/territory programs off the ground, which would ensure more people with Medicaid can receive high-quality, cost-effective, person-centered services in a setting they choose.

“NAHC has long supported the Money Follows the Person program,” said NAHC Director of Government Affairs Calvin McDaniel. “The announced funds will provide additional investment and opportunities for states to enhance their HCBS offerings. Continued investments in HCBS further rebalances spending on long-term services and supports in favor of the home. This investment is consistent with President Biden’s goals of improving access to care in the home. NAHC encourages the eligible states and territories to apply for these new funds.”

HCBS is a critical component of the Medicaid program and the MFP program has been a critical tool, now with the potential to do more in a broader array of states and territories.

To help additional states and territories implement MFP, these awards will support the early planning phase to get an MFP program off the ground. This includes:

  • Establishing partnerships with community stakeholders, including those representing diverse and underserved populations, Tribal entities and governments, key state and local agencies (such as state and local public housing authorities), and community-based organizations;
  • Conducting system assessments to better understand how HCBS support local residents;
  • Developing programs for the types of community transitions MFP supports;
  • Establishing or enhancing Medicaid HCBS quality improvement programs;
  • Recruiting HCBS providers as well as expert providers for transition coordination and technical assistance; and
  • Conducting a range of planning activities deemed necessary by the award recipients and approved by CMS.

State Medicaid agencies not currently participating in the MFP demonstration may apply through the NOFO no later than May 31, 2022. To access the NOFO, visit Grants.gov or here https://www.grants.gov/web/grants/view-opportunity.html?oppId=334196

For states already participating in MFP, CMS also announced that the agency is increasing the reimbursement rate for MFP “supplemental services.” These services will now be 100% federally funded with no state share. Further, CMS is expanding the definition of supplemental services to include additional services that can support an individual’s transition from an institution to the community, including short-term housing and food assistance. These changes will help further address critical barriers to community living for eligible individuals, as well as increase community transition rates and the effectiveness of the MFP demonstration overall. For more information on current and previous grantees, visit Medicaid.gov. CMS will provide additional information on these changes to MFP grantees.

“Everyone deserves the opportunity to live at home, in their communities, and with their loved ones,” said Health & Human Services (HHS) Secretary Xavier Becerra. “This funding will bring dignity and peace of mind to even more seniors and people with disabilities across the country. We will continue expanding these programs to ensure all Americans have equitable access to the high-quality health care they deserve—no matter where they live.”

Money Follows the Person Demonstration Expansion: Notice of Funding Opportunity (NOFO) Webinars for Applicants

CMS released a Notice of Funding Opportunity that will offer up to $110 million to expand access to home and community-based services (HBCS) through Medicaid’s Money Follows the Person (MFP) program. The new NOFO authorized under the Consolidated Appropriations Act of 2021 (CAA) will make individual awards of up to $5 million to states and territories that are not currently participating in MFP. These funds will support states during the initial planning and implementation of their programs.

CMS will hold two webinars to provide details about the MFP Demonstration Expansion, and to answer questions from potential applicants regarding this funding opportunity. Registration is required. The webinars will be held:

April 13, 2022 1:00 pm to 2:00 pm (ET)

Registration: Click on https://cms.zoomgov.com/j/1601853787?pwd=Vm9UTUoyRnpVVStjSEo1QlZYWURPUT09

April 27, 2022 1:00 pm to 2:00 pm (ET)

Registration: Click on  https://cms.zoomgov.com/j/1612862544?pwd=MGd3YW5nUVJ4T050bWFraTV6V0Y1UT09

Senate Debates Expansion of Medicaid HCBS

The Senate Special Committee on Aging met this week to debate the improvement and expansion of home-based services, particularly home-and-community based services, a consistent priority for committee chairman Senator Bob Casey (D-PA). Witnesses and Senators frequently cited. Casey’s Better Care Better Jobs (BCBJ) Act, strongly supported by NAHC, as it is the foundation for the HCBS provisions included in the Build Back Better (BBB) Act, the stalled health care, social service, and climate legislation that was a focus for much of 2021.

The most recent version of that legislation passed by the House of Representatives would provide $150 billion investment into Medicaid HCBS, permanency of the Money Follows the Person program, protections against spousal impoverishment for HCBS recipients, and several other policies intended to improved the provision of Medicaid HCBS.

Witnesses testimony focused on the current state of HCBS through explanation of statistics and data on the workforce, wages, patient need, and expected growth over the next eight to ten years. Witnesses highlighted the challenges that recipients are able to overcome with the assistance of home care, as well as the realities they face in the absence of care. They also highlighted challenges caregivers face in wages not competitive with other industries, feelings of isolation, and the grueling work. These accounts were paired with support for the Better Care Better Jobs Act.

While many of the witnesses lauded the HCBS funding included in the American Rescue Plan, passed in March 2021, they did add that it did not provide a permanent solution. Anne Tumlinson likened it to an “umbrella in a hurricane.”

At the hearing, the witness panel was comprised of Lisa Harootunian, Associate Director, Health Program, Bipartisan Policy Center, Anne Tumlinson, CEO, ATI Advisory, Brandon Kingsmore, Disability Advocate, Public Speaker, accompanied by Ms. Lynn Weidner, Home Care Worker, and Alene Shaheed, Home Care Recipient.

While the version of Build Back Better passed by the House is not expected to see further consideration in the Senate, work continues to be done on compiling a package of provisions consistent with the intent of BBB, though no specifics seem to be agreed to at this point.

NAHC will continue to urge Congress to make significant investments into the Medicaid HCBS program.

Congress Debates HCBS Expansion, Improvement for Veterans

The Elizabeth Dole HCBS for Veterans and Caregivers ActH.R. 6823 introduced in the U.S. House of Representatives earlier this month and would work to improve home and community-based services (HCBS) services for patients, their families, and their caregivers.

NAHC previously reported on it here.

Specifically, this legislation would:

  • Expand access to HCBS services for veterans living in US territories and to Native veterans enrolled in IHS or tribal health program.
  • Raise the cap on how much the VA can pay for the cost of home care from 65% of the cost of nursing home care to 100%.
  • Coordinate expanded VA home care programs with other VA programs.
  • Establish a pilot project to address home health aide shortages.
  • Providing respite care to caregivers of veterans enrolled in home care programs.
  • Establish a “one stop shop” webpage to centralize information for families and veterans on programs available.
  • Require the VA to provide a coordinated handoff for veterans and caregivers denied or discharged from the Program of Comprehensive Assistance for Family Caregivers into any other home care program they may be eligible for.

Following the introduction of the Elizabeth Dole Home and Community Based Services for Veterans and Caregivers Act, the House Committee on Veterans’ Affairs held a hearing on the bill, and several other pieces of legislation designed to improve the Veterans Administration (VA) and health care delivery for veterans.

In written testimony, Dr. Julianne Flynn, Acting Assistant Under Secretary for Health Care within the Veterans Health Administration offered support for numerous provisions included in H.R. 6823, in particular the increase of to 100% of what the VA can pay for home based on the cost of nursing home care. Likewise, the legislation received favorable comments from other members of the panel as well as testifying witnesses from the Elizabeth Dole Foundation and the Paralyzed Veterans of America.

NAHC supports this legislation as it will make much needed improvements for veterans receiving home care through increased accessibility, improved coordination, and caregiver support.

Senate Debates Expansion of Medicaid HCBS

The Senate Special Committee on Aging met this week to debate the improvement and expansion of home-based services, particularly home-and-community based services, a consistent priority for committee chairman Senator Bob Casey (D-PA). Witnesses and Senators frequently cited. Casey’s Better Care Better Jobs (BCBJ) Act, strongly supported by NAHC, as it is the foundation for the HCBS provisions included in the Build Back Better (BBB) Act, the stalled health care, social service, and climate legislation that was a focus for much of 2021.

The most recent version of that legislation passed by the House of Representatives would provide $150 billion investment into Medicaid HCBS, permanency of the Money Follows the Person program, protections against spousal impoverishment for HCBS recipients, and several other policies intended to improved the provision of Medicaid HCBS.

Witnesses testimony focused on the current state of HCBS through explanation of statistics and data on the workforce, wages, patient need, and expected growth over the next eight to ten years. Witnesses highlighted the challenges that recipients are able to overcome with the assistance of home care, as well as the realities they face in the absence of care. They also highlighted challenges caregivers face in wages not competitive with other industries, feelings of isolation, and the grueling work. These accounts were paired with support for the Better Care Better Jobs Act.

While many of the witnesses lauded the HCBS funding included in the American Rescue Plan, passed in March 2021, they did add that it did not provide a permanent solution. Anne Tumlinson likened it to an “umbrella in a hurricane.”

At the hearing, the witness panel was comprised of Lisa Harootunian, Associate Director, Health Program, Bipartisan Policy Center, Anne Tumlinson, CEO, ATI Advisory, Brandon Kingsmore, Disability Advocate, Public Speaker, accompanied by Ms. Lynn Weidner, Home Care Worker, and Alene Shaheed, Home Care Recipient.

While the version of Build Back Better passed by the House is not expected to see further consideration in the Senate, work continues to be done on compiling a package of provisions consistent with the intent of BBB, though no specifics seem to be agreed to at this point.

NAHC will continue to urge Congress to make significant investments into the Medicaid HCBS program.

Senate Debates Expansion of Medicaid HCBS

The Senate Special Committee on Aging met this week to debate the improvement and expansion of home-based services, particularly home-and-community based services, a consistent priority for committee chairman Senator Bob Casey (D-PA). Witnesses and Senators frequently cited. Casey’s Better Care Better Jobs (BCBJ) Act, strongly supported by NAHC, as it is the foundation for the HCBS…

Congress Debates HCBS Expansion, Improvement for Veterans

The Elizabeth Dole HCBS for Veterans and Caregivers Act, H.R. 6823 introduced in the U.S. House of Representatives earlier this month and would work to improve home and community-based services (HCBS) services for patients, their families, and their caregivers. NAHC previously reported on it here. Specifically, this legislation would: Expand access to HCBS services for veterans…