About 656,000 folks throughout the nation have been on state ready lists for house and community-based providers financed via Medicaid waivers in 2021, finds a brand new KFF evaluation. However such ready lists are an incomplete and sometimes inaccurate measure that may each overstate and understate unmet want.
The information about ready lists are among the many newest findings from the twentieth KFF survey of state officers administering Medicaid HCBS packages in all 50 states and Washington DC.
Ready lists can generally overstate the necessity for providers as a result of not all states display for Medicaid eligibility earlier than including folks to their lists, which inflates the numbers with individuals who might by no means be eligible for providers. In all years since 2016, over half of individuals on HCBS ready lists lived in states that didn’t display folks on ready lists for eligibility, the brand new evaluation discovered. This is also a key purpose that ready lists should not comparable throughout states.
Ready lists may also understate want. They replicate the populations a state chooses to serve, in addition to the sources it commits. In lots of circumstances, folks may have extra providers, however as a result of the state doesn’t provide them—or doesn’t provide them to particular populations, comparable to folks ages 65 and older—they might not seem on a ready listing.
HCBS ready lists stay a supply of concern to policymakers and proposals to remove them have been put forth by each Republicans and Democrats.
Most of the different findings from the 50-state survey deal with power workforce shortages that have been exacerbated by the COVID-19 pandemic and are the most important challenges dealing with state Medicaid HCBS packages. Key takeaways from that evaluation embody:
- Amid the pandemic, HCBS workforce shortages have contributed to supplier closures. Most states (44) reported a everlasting closure of at the least one Medicaid HCBS supplier throughout the pandemic, up from 30 states in 2021.
- Nearly all states (48) responded to the workforce disaster by rising HCBS supplier cost charges. States additionally elevated self-directed and household caregiving alternatives for HCBS beneficiaries. All states provide at the least one HCBS program with the choice for enrollees to self-direct their providers. Forty-eight states permit legally accountable kinfolk to be paid caregivers, up from 36 states in 2020.
- When requested how they used non permanent funding from the American Rescue Plan Act of 2021, over two-thirds of states (35) reported initiatives with excessive start-up prices that have been usually time-limited to keep away from increased ongoing prices after the improved federal funding ended. A few of the commonest initiatives included providing suppliers bonuses or incentive funds to remain on, growing or increasing employee coaching or certification packages, and upgrading IT programs.
The complete analyses of the survey findings can be found right here:
For extra knowledge and analyses about Medicaid HCBS, go to kff.org.