Home- & Community-Based Services (HCBS)

Shifting spending and delivery of long-term services and supports (LTSS) from institutions to the home and community is often referred to as rebalancing. This report and brief describe variation in LTSS rebalancing between 2016 and 2019 by enrollee age, health condition, and demographic factors.

This New Jersey case study provides insights into the daunting challenges states face in seeking to address the home care worker shortage, which has become more acute as New Jersey and other states have striven to “re-balance” Medicaid long-term services and supports use and spending away from institutional care toward home and community-based services.

Direct care workers (DCWs) such as nursing assistants, home health aides, and personal care assistants play an essential role in the health and well-being of over 20 million Americans. Yet DCW wages are not enough to make jobs competitive with entry level positions in other industries with similar job requirements which exacerbates the challenges in recruitment and retention of these workers.

People living with dementia often have complex health and social support needs that can best be met by health care and community-based providers working together. This brief examines promising practices for bridging community-based organizations and health care systems in the providing comprehensive dementia care.

People experiencing homelessness often have complex health care and social service needs which present significant care challenges to hospitals, such as longer lengths of stays, higher readmission rates, and complicated chronic illnesses.

State Medicaid programs have the option to cover supported employment services, but use of these services by the Medicaid population has not been widely studied.

This report outlines a feasibility study focused on obtaining identifiers for self-directed Home and Community-Based Services (HCBS) users within Medicaid claims data. Financial Management Services (FMS) entities assist individuals in managing the financial aspects of self-directed care, including payroll and billing.

States may use Appendix K to modify their existing Medicaid home and community-based services (HCBS) 1915(c) waiver programs during emergency situations. During the COVID-19 public health emergency, states used Appendix K to make temporary changes to access and eligibility, payment, services, and other aspects of their waiver programs.

Prior research from the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) and U.S. Department of Housing and Urban Development (HUD) Office of Policy Development and Research (PD&R) show older adults receiving federal housing assistance face disproportionately high rates of chronic conditions and health care utilization.

On April 25, 2024, HHS and DoL released recommendations, in the form of an Issue Brief, to improve data infrastructure on the workforce delivering home and community-based services (HCBS) in response to President Biden’s