What are HCBS’s?
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Home and Community-Based Services
You may have heard the term “HCBS.” It is the acronym for “Home and Community-Based Services,” a Medicaid waiver program that assists Medicaid beneficiaries in receiving services in their own homes or communities. These services often include support with functional limitations like dressing and bathing, transportation, visits from healthcare providers, and case management. The need for this type of care is expected to skyrocket as America’s aging population expands to 74 million in 2030.
Current policy and budgeting efforts are underway to bolster the country's HCBS programs to better support the “care infrastructure" provided by the 53 million Americans who care for vulnerable seniors and people with disabilities. The timing is key, considering most states' long waitlists for waivers.
President Biden has proposed increasing federal support for home-based long-term care by $400 billion in his American Jobs Plan over eight years. A $50 billion annual increase would represent a roughly 40 percent increase in the $129 billion Medicaid spent on long-term care in 2018 and a 70 percent increase in that year’s home and community-based services (HCBS) budget. This move reflects a widely held belief that aging Americans should have the choice to stay in their homes and that this is a more cost-effective option than nursing home care.
Increasing pay and benefits to Caregivers
One key component of the plan is to increase pay and benefits for the more than 790,000 caregivers providing HCBS support. The majority of these are women, immigrants, and people of color, who are paid an average of $12 an hour, and 1/3 of whom receive no employer-backed health insurance. Recruiting quality caregivers as demand grows will be increasingly difficult without these improvements to wages and benefits.
William A. Dombi, President of the National Association for Home Care & Hospice, praises these efforts as a “monumental advance” in the “effort to provide full access to health care outside of an institution.”
Limitations
Of course, there are limitations to the reach of HCBS programs. Medicaid’s strict eligibility requirements limit services to individuals who can demonstrate that they have no more than $2,000 in total assets, hindering the program’s ability to help lower-to-upper-middle-class individuals and families.
Working with an Elder Law Attorney who understands the Medicaid application process and tracks the cost of nursing home care can be helpful as families plan for the future. An effective legal advisor will counsel clients on how they might achieve their goals, whether maintaining independence and dignity, preserving funds for children and grandchildren, or staying home rather than moving to assisted living or a nursing home.