Feds Extends American Rescue Plan Spending Deadline for States to Expand Medicaid HCBS

  • States will have an additional year to use American Rescue Plan funds to strengthen the home care workforce and expand access to services

On Friday, June 3, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is notifying states that they now have an additional year — through March 31, 2025 — to use funding made available by the American Rescue Plan (ARP) to enhance, expand, and strengthen home- and community-based services (HCBS) for people with Medicaid who need long-term services and supports.

As the primary funder of HCBS nationally, Medicaid plays a critical role in supporting states’ efforts to strengthen these services for their beneficiaries. Section 9817 of the American Rescue Plan provides states with a temporary 10 percentage point increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures for HCBS — an estimated $12.7 billion. As a result of the ARP increase in the federal matching rate on activities, states originally had a three-year period — from April 1, 2021 through March 31, 2024 — to use the available state funds, attributable to the ARP’s increased FMAP, on activities to enhance, expand, or strengthen HCBS in Medicaid. The extended timeframe, of an additional year, will help to facilitate high-quality, cost-effective, person-centered services for people with Medicaid. This will allow Medicaid beneficiaries to remain in the setting of their choice—whether it is their home or another setting—and remain a valued part of their communities.

This ARP funding allows states to identify and implement changes aimed at addressing existing HCBS workforce and structural issues. It will also help expand states’ capacity to provide critical services and meet the needs of family caregivers and people on HCBS waitlists. Moreover, states can use these funds to tailor HCBS activities based on the needs and priorities of their residents. For example, states can use the funds to provide additional support to address the continued impact of the COVID-19 pandemic on individuals who need long-term services and supports, who are at higher risk for contracting COVID-19, and who might otherwise be in more costly nursing homes and other institutions instead of their own homes. Some states are also using the funds to increase pay and benefits for direct service workers, which many states were unable to do before the ARP funding increase due to funding shortages and restrictions.

“Everyone deserves the dignity to live in their own homes and communities, and the Biden-Harris Administration is committed to protecting that right,” said HHS Secretary Xavier Becerra. “Thanks to extended funding from President Biden’s American Rescue Plan, we are expanding home- and community-based services for millions of aging Americans and people with disabilities across the country. We are working hand-in-hand with states to ensure they have the time and support they need to strengthen their home care systems and workforce.”

“With this extension, we are addressing states’ concerns, giving states the time and resources to strengthen connections to care at home and in communities,” said CMS Administrator Chiquita Brooks-LaSure.

The COVID-19 pandemic has exposed the risks of institutional and congregate settings for older Americans and people with disabilities, underscoring the urgent need to expand access to high-quality HCBS to improve outcomes for people who need long-term services and supports. HCBS allow millions of Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings.

Critical safeguards are in place through the ARP legislation and CMS’ guidance to certify that these funds are used appropriately. Between now and the March 2025 deadline, CMS will continue to monitor states’ progress and compliance to ensure funding is used to strengthen HCBS under their Medicaid program.

Additional information on states’ spending plans — including a recently updated infographic summarizing planned activities and key investments — can be found at Medicaid.gov https://www.medicaid.gov/medicaid/home-community-based-services/guidance/strengthening-and-investing-home-and-community-based-services-for-medicaid-beneficiaries-american-rescue-plan-act-of-2021-section-9817-spending-plans-and-narratives/index.html.

To review the guidelines for the use of the ARP funds, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/smd21003.pdf.

To review the State Medicaid Director Letter extending the spending deadline, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/smd22002.pdf.

Feds Extend American Rescue Plan Spending Deadline for States to Expand Medicaid HCBS

  • States will have an additional year to use American Rescue Plan funds to strengthen the home care workforce and expand access to services

On Friday, June 3, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is notifying states that they now have an additional year — through March 31, 2025 — to use funding made available by the American Rescue Plan (ARP) to enhance, expand, and strengthen home- and community-based services (HCBS) for people with Medicaid who need long-term services and supports.

“This is very good news,” said NAHC President William A. Dombi. “The ARPA funds are desperately need in Medicaid HCBS but using those founds properly has been a complex undertaking for the states. The added time to use the funds is very welcome.”

As the primary funder of HCBS nationally, Medicaid plays a critical role in supporting states’ efforts to strengthen these services for their beneficiaries. Section 9817 of the American Rescue Plan provides states with a temporary 10 percentage point increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures for HCBS — an estimated $12.7 billion. As a result of the ARP increase in the federal matching rate on activities, states originally had a three-year period — from April 1, 2021 through March 31, 2024 — to use the available state funds, attributable to the ARP’s increased FMAP, on activities to enhance, expand, or strengthen HCBS in Medicaid. The extended timeframe, of an additional year, will help to facilitate high-quality, cost-effective, person-centered services for people with Medicaid. This will allow Medicaid beneficiaries to remain in the setting of their choice—whether it is their home or another setting—and remain a valued part of their communities.

This ARP funding allows states to identify and implement changes aimed at addressing existing HCBS workforce and structural issues. It will also help expand states’ capacity to provide critical services and meet the needs of family caregivers and people on HCBS waitlists. Moreover, states can use these funds to tailor HCBS activities based on the needs and priorities of their residents. For example, states can use the funds to provide additional support to address the continued impact of the COVID-19 pandemic on individuals who need long-term services and supports, who are at higher risk for contracting COVID-19, and who might otherwise be in more costly nursing homes and other institutions instead of their own homes. Some states are also using the funds to increase pay and benefits for direct service workers, which many states were unable to do before the ARP funding increase due to funding shortages and restrictions.

“Everyone deserves the dignity to live in their own homes and communities, and the Biden-Harris Administration is committed to protecting that right,” said HHS Secretary Xavier Becerra. “Thanks to extended funding from President Biden’s American Rescue Plan, we are expanding home- and community-based services for millions of aging Americans and people with disabilities across the country. We are working hand-in-hand with states to ensure they have the time and support they need to strengthen their home care systems and workforce.”

“With this extension, we are addressing states’ concerns, giving states the time and resources to strengthen connections to care at home and in communities,” said CMS Administrator Chiquita Brooks-LaSure.

The COVID-19 pandemic has exposed the risks of institutional and congregate settings for older Americans and people with disabilities, underscoring the urgent need to expand access to high-quality HCBS to improve outcomes for people who need long-term services and supports. HCBS allow millions of Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings.

Critical safeguards are in place through the ARP legislation and CMS’ guidance to certify that these funds are used appropriately. Between now and the March 2025 deadline, CMS will continue to monitor states’ progress and compliance to ensure funding is used to strengthen HCBS under their Medicaid program.

Additional information on states’ spending plans — including a recently updated infographic summarizing planned activities and key investments — can be found at Medicaid.gov https://www.medicaid.gov/medicaid/home-community-based-services/guidance/strengthening-and-investing-home-and-community-based-services-for-medicaid-beneficiaries-american-rescue-plan-act-of-2021-section-9817-spending-plans-and-narratives/index.html.

To review the guidelines for the use of the ARP funds, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/smd21003.pdf.

To review the State Medicaid Director Letter extending the spending deadline, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/smd22002.pdf.

Feds Extend American Rescue Plan Spending Deadline for States to Expand Medicaid HCBS

States will have an additional year to use American Rescue Plan funds to strengthen the home care workforce and expand access to services On Friday, June 3, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is notifying states that they now have an additional year…

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 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…

NAHC to Congress: Big Investment in HCBS is Needed Now

The National Association for Home Care & Hospice has joined a large group of likeminded organizations in urging leaders in both houses of Congress and both parties to ensure that Medicaid Home and Community Based Services (HCBS) remain part of any package that moves forward. A large investment is essential for building a sustainable HCBS infrastructure that can begin to address the magnitude of need in our communities, both increasing access to Medicaid HCBS and addressing the direct care workforce crisis–creating more direct care jobs to support people with disabilities and aging adults, and making those jobs better.

To address the long-standing inequities the pandemic exposed and exacerbated, this investment is critical to fortify a workforce that must continue to 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 can 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.

Due in large part to a long history of inadequate funding at the federal level, the system itself is not serving everyone who needs HCBS, even though most people far prefer to remain in their homes as they age, and research has shown that quality of life is significantly improved when individuals are able to live in the community. Further, people with disabilities of all ages have a legal right to receive services and supports in the most integrated setting, regardless of the source of payment for services. Yet, 31 years after the passage of the Americans with Disabilities Act, over 800,000 people with disabilities are currently on waiting lists for the Medicaid-funded services needed to make that possible, and many more are entering institutions against their wishes because they do not have qualified and trained direct care staff to support them in the setting of their choice. These waiting lists leave people with disabilities, aging adults and their families waiting years and even decades for services. The investments in the Build Back Better Agenda are crucial to reach this as yet unrealized goal of the Americans with Disabilities Act.

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. The costs of this inadequate system fall disproportionately on people of color with limited income and wealth. The workforce and earnings losses related to unpaid family caregiving are significant and well-documented.

NAHC urges Congress to continue to include and prioritize the large investment in the infrastructure of Medicaid HCBS, and the workforce that provides them, as lawmakers negotiate any package moving forward.

NAHC to Congress: Big Investment in HCBS is Needed Now

The National Association for Home Care & Hospice has joined a large group of likeminded organizations in urging leaders in both houses of Congress and both parties to ensure that Medicaid Home and Community Based Services (HCBS) remain part of any package that moves forward. A large investment is essential for building a sustainable HCBS infrastructure…

The Better Care Better Jobs Act Means a Stronger Home Care Community

Tell your elected representatives in Congress to support the Better Care Better Jobs Act! Senator Bob Casey (D-PA), long-time champion of in-home care and sponsor of the Better Care Better Jobs Act, has released a set of nationwide and individual state reports on the projected impact his Better Care Better Jobs Act will have on workers and recipients of care…

The Better Care Better Jobs Act Means a Stronger Home Care Community

Senator Bob Casey (D-PA), long-time champion of in-home care and sponsor of the Better Care Better Jobs Act, has released a set of nationwide and individual state reports on the projected impact his Better Care Better Jobs Act will have on workers and recipients of care in the home.

These factsheets present a clear and concise picture of the need for Medicaid Home and Community-based Services (HCBS), comparison of cost of care between the home and congregate settings, as well as waitlist length for HCBS Services where applicable. In addition, the factsheets demonstrate the impact the Better Care Better Jobs Act would have on workforce shortages.

“For millions of families, and especially for women, home and community-based services are a bridge to work and a bridge to economic security,” said Senator Casey when introducing the legislation. “The Better Care Better Jobs Act would not only enable more older adults and people with disabilities to remain in their homes, stay active in their communities and lead independent lives, it would also create jobs and lead to higher wages for care workers, who are predominantly women and people of color. This legislation is critical to advancing equity, spurring economic recovery, and improving quality of life for older adults and people with disabilities”

The National Association for Home Care and Hospice is in full support of the Better Care Better Jobs Act and is working with Congress to ensure it is included in the budget reconciliation currently being developed in Congress. President Biden originally called for an investment into the HCBS program to the tune of $400 billion. The most recent house version of the reconciliation package allocated $190 billion, which could be susceptible to further cuts as negotiations work towards a final package.

NAHC encourages members to support robust funding of the Better Care Better Jobs Act andThe reports from Senator Casey can be helpful in these efforts.