Pass the HCBS Access Act
Recommendation
Congress should pass the Home and Community Based Services (HCBS) Access Act, which would make HCBS a mandatory benefit within Medicaid and ensure eligible older adults and individuals with disabilities can choose between home care and institutional care.[1][2]
Background/summary
Older adults and individuals with disabilities may require long-term care.[2] An estimated 11 million Americans qualify for long-term services and supports (LTSS).[3] Those who qualify for LTSS may have a range of physical or mental health or substance use disorder (MH/SUD) needs which require intensive caregiving. Qualified individuals face two paths to long-term care: institutional care in a facility or care provided through HCBS.[2] HCBS provide significant support to those who require long-term care, including home health aides, case management, adult day care, and more, while allowing patients to remain at home.[4]
While most states currently offer HCBS waivers, many who qualify for LTSS find themselves on long waiting lists for a waiver, and when care is needed immediately, eventually turn to institutional care despite preferring to remain at home.[2] Individuals with a MH/SUD that requires long-term care should not feel forced into institutional facilities when they would prefer to remain at home and can do so with better outcomes.[5] Congress should pass the HCBS Access Act, which would require Medicaid to allow all eligible adults to choose between receiving care at home or another facility.
citations
1. HCBS Access Act. S.762 (Casey) and H.R.1493(Dingell), 118th Congress (2023-2024). Last Accessed March 2023
2. Rep. Debbie Dingell. Dingell, Casey, Bowman, Introduce Legislation to Make Home Care Coverage Mandatory Under Medicaid. 2023. Congresswoman Debbie Dingell. Last Accessed March 9, 2023.
3. Mathematica. Medicaid Beneficiaries Who Use Long-Term Services and Supports: 2019. Last Accessed July 22, 2022.
4. U.S. Department of Health and Human Services. The Centers for Medicare and Medicaid Services. Home & Community-Based Services 1915(c). Last Accessed July 6, 2023.
5. Justin Blackburn, Julie L. Locher, and Meredith L. Kilgore. Comparison of Long-term Care in Nursing Homes Versus Home Health: Costs and Outcomes in Alabama. The Gerontologist. Last Accessed April 1, 2016.