Typically, those efforts have fallen under four buckets. Exactly how they plan to use the funding is still a work in progress, but a new Kaiser Family Foundation (KFF) analysis offers several possible strategies by highlighting how states have leveraged Section 1115 demonstration waivers. In some cases, states have used additional resources to streamline eligibility processes and the overall start of care, according to KFF. In others, states have expanded financial eligibility rules to help certain enrollees afford to live in their home or community instead of a long-term care institution.
Moving forward, there’s a good chance that not all states will pursue the increased FMAP, as the federal bump would only be made available for one year. Accepting federal help to make big investments in HCBS, some states believe, would create a future financial cliff when that help goes away. “Millions of individuals across the county — including people with disabilities and older Americans — rely on home-based care and the workforce that provides that critical care,” Xavier Becerra, secretary of the U.S. Department of Health and Human Services (HHC), said in a May announcement. “The Biden-Harris administration continues to support states and workers by making critically needed investments in home- and community-based services.”
Still, there are states currently in the process of developing plans to access the increased FMAP. Broadly, ARPA paved the way for states to receive more federal funding to expand existing HCBS, as long as they followed certain guidelines.
Washington has taken such steps with its Tailored Support for Older Adults (TSOA) program, which creates a new eligibility pathway and benefit package for otherwise ineligible adults older than 55 who require a nursing-facility level of care. Elsewhere, Rhode Island’s 1115 waiver covers young adults ages 19 to 21 who age out of HCBS programs for medically fragile children. Finally, some states have also used additional resources to offer entirely new services through alternative benefit packages. In other instances, states have looked to bolster HCBS by opening up services to additional populations.
“An evaluation of New York’s waiver has found positive impacts among individuals transitioning out of institutional settings, including that high percentages of enrollees remained in the community,” the KFF analysis reads. Rhode Island, for example, has used waiver flexibility to authorize HCBS benefits to new long-term care applicants during a presumptive eligibility period while final financial eligibility determinations are pending. New York has used waiver authority to implement a special “income disregard” that factors in rent costs when determining HCBS financial eligibility.
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