This week, the Medicare Rights Center submitted comments in response to a discussion draft of a bill to expand access to Medicaid Home and Community Based Services (HCBS). The draft bill, the HCBS Access Act of 2021 (HAA), was released for comment by Senators Brown (D-OH), Casey (D-PA), and Hassan (D-NH) along with Representative Dingell (D-MI). It aims to rectify Medicaid’s institutional biases that favor access to nursing homes, even when HCBS are preferred by many people and families.
At its center, the bill addresses the fact that while coverage for nursing home care is a mandatory Medicaid benefit, HCBS funding is optional. This has resulted in more variation in HCBS rules and programs across states, confusing eligibility criteria, and long waitlists or totally unavailable services, leaving people with no option but to enter a nursing home or other congregate setting to get their care needs met. The current situation does not respect patient and family choices or preferences, fails to uphold the promise of federal law requirements to provide for people in the least restrictive setting appropriate to their needs, and, as we have seen during the COVID-19 pandemic, can put people at increased risk of further disability, isolation, and death.
We applaud the legislators for taking action to address the utterly inadequate status quo and appreciate that HAA would greatly expand access to HCBS – helping people stay in their communities and age in place as they choose. In our comments, we make small suggestions to better achieve more equitable access to these essential improvements to the Medicaid program.
Most notably, it is important to recognize that HCBS care, like nursing home care, is completely dependent on the quality and sufficiency of the caregiving workforce. HCBS workers must have livable wages, sufficient training, leave, protections, and certification. Also essential is the creation of a HCBS ombuds program to facilitate the resolution of problems; provide oversight to ensure access to needed services; and to track, identify, and report systemic problems with enrollment, eligibility, and access to services.