Home and Community-Based Services

How It Works

Home and community-based services are services that are not traditionally perceived as “medical” but without access to the services individuals are at risk for institutionalization, i.e. a hospital or skilled nursing facility. Examples of services include: home nursing, home or environmental modifications to accommodate a child’s needs, home health aides who can assist in daily activities like bathing, and respite care.

Home and community based services are optional services available to Medicaid consumers. States also have the option to apply to the federal government for a Section 1915 HCBS Waiver, which expands eligibility to home and community based services for children with severe disabilities but whose families do not meet income eligibility or asset testing.

History

These waivers were created in response to a family who got the attention of President Reagan when they wanted to bring their daughter, Katy Beckett, home from a lengthy stay in the hospital. While “out of the home” (i.e. in a hospital or skilled nursing facility), parental income does not “count” for SSI eligibility. However, while in the home, parental income does count towards determining eligibility. Therefore, while Katy Beckett received extensive medical care through SSI/Medicaid benefits while in the hospital, upon entering her family home, she lost all benefits. The family could not afford to keep her at home without Medicaid benefits, including the home and community based services provided under Medicaid in her state. To ameliorate the discrepancies in services that a child receives depending on their living situation, special HCBS waivers for children with special needs were developed.

Policy Update

  1. Increasing availability of HCBS under Medicaid. The Community Choice Act of 2007 has been introduced into the House (HR 1621) and Senate (S 799). Essentially both bills amend Medicaid to require each state to provide individuals with disabilities with equal access to community-based attendant services and supports. Because HCBS are offered to patients with Medicaid only if their state choices to offer HCBS as an optional service, this will expand access to HCBS for many Medicaid enrollees.

    To learn about the waivers offered in your state, see the Kaiser Family Foundation’s Benefits by Service: Home and Community Based Services Waiver (October 2004), available at: http://www.kff.org/medicaid/benefits/

  2. Increasing access to Waivers. While all states offer HCBS waivers, the waivers are often offered such that participants must meet particular eligibility categories and there are limits to the number of people who may be offered waivers. This has created waiting lists of potential enrollees. While overall spending for HCBS waivers has increased, overall spending on waivers for children has recently fell by 16% (Medicaid 1915(c) Home and Community-Based Service Programs: Data Update, December 2006. Kaiser Family Foundation). This has created an opportunity for advocates to lobby on the state level for enhanced funding for children’s waiver programs.

Links

  • Kaiser Family Foundation

References