Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 6. Home and Community-based Services


Medicaid-covered HCBS may be available under an HCBS waiver (1915c) or they may be optional HCBS services covered without a waiver under a Medicaid SPA (1915i). HCBS are intended to offer alternatives to institutional care for people with disabling health conditions. The Kaiser Commission on Medicaid and the Uninsured reports that the national percentage of Medicaid spending on HCBS more than doubled from 1998 to 2009, reflecting a growing interest among policy makers, government officials, and health care providers in responding to the wishes of consumers and family members to support the ability of seniors and people with disabilities to continue living in the community as an alternative to nursing homes and other forms of institutional care.28

HCBS waiver services may include home-based nursing, case management, homemaker services (to prepare meals and assist with household chores), and other services that allow people who are very frail or disabled to live in their own home or apartment. These services can supplement the level of supportive services provided in most PSH, making it more appropriate for very vulnerable chronically homeless people, particularly older people and those with severe mental illness or disabling physical conditions.

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