The Kaiser Family Foundation (KFF) has published an issue brief titled, "Streamlining Medicaid Home and Community-Based Services: Key Policy Questions," which examines the concept of a streamlined Medicaid state plan Home and Community Based Services (HCBS) authority. The paper was co-authored by Henry Claypool, MaryBeth Musumeci, and Mary Sowers.
The issue brief draws on features of the various existing Medicaid HCBS programs to identify key policy questions raised by initiatives to streamline Medicaid HCBS. These include:
- How would financial eligibility for HCBS be determined?
- How would states manage program enrollment?
- How would beneficiaries functionally qualify for services?
- How would HCBS be incentivized?
- How would the program be administered, monitored, and evaluated?
The paper describes the growing need for HCBS and Medicaid’s role in financing such services, and examines the history of HCBS policy within Medicaid, identifying the roots of the program’s institutional bias and detailing “a 35 year incremental approach to system design” within Medicaid’s HCBS authorities. The brief suggests that “while substantially increasing beneficiary access to HCBS, these initiatives also have resulted in a patchwork of options, contributing to administrative complexity for states and confusion for individuals seeking services.”
Streamlining Medicaid HCBS, the authors say, “might alleviate some of the complexity and administrative costs associated with the program and support further progress in increasing beneficiary access to HCBS.” The existing Section 1915(i) option for states to provide HCBS as Medicaid state plan benefits “has streamlined some program elements, such as the menu of available services and can inform the design of a streamlined HCBS option.” Any changes to Medicaid HCBS programs, the brief points out, “will have to address how to ensure adequate financing, which is central to any streamlining effort, and how to manage program enrollment over time.” The authors suggest “next steps in streamlining Medicaid HCBS,” including “engaging a variety of stakeholders; considering options to address potential concerns; and exploring financing mechanisms and the federal and state fiscal implications of a streamlined program.