Barriers to HCBS Implementation
There have been shifts in the HCBS landscape and policies implemented, including HCBS expansion, such as through the American Rescue Plan Act. Yet despite increased interest and support for HCBS, many challenges remain, including:
- HCBS workforce shortages
- Service access inequities by geography and recipient population
- Lack of support for informal caregivers
- Challenges with HCBS quality measurement
- The impact of COVID-19 on HCBS
- Disparate Medicare and Medicaid policies regarding coverage for HCBS
- Social determinants of health affected by HCBS
- Limited access to grant-funded and non-medical HCBS
- Growing need for condition-specific HCBS, including Alzheimer’s Disease and related dementias
CMS, ACL, and other federal clients are focusing on HCBS expansion and improvement as a way of reducing health care costs, while providing a more person-centered approach to care. Increasingly, health coverage has been expanding to include non-medical HCBS, such as through Medicare Advantage Plans and via Medicaid waivers, to support the matrix of structural and social needs that may affect health. Moving into HCBS quality measurement also has been a new growth area, as defining quality for such a diverse array of services can prove challenging, particularly while also ensuring that services meet diverse needs and support equity goals.
How RTI is Addressing Innovative Approaches to HCBS
RTI’s experts in health policy, aging, disabilities, health equity, and social determinants of health are uniquely positioned to understand and address these challenges by leveraging decades of experience evaluating the facilitators and barriers of innovative approaches to HCBS. Key areas of RTI research include:
- Developing critical assessments of HCBS payment, including Medicaid (e.g., Section 1915 (c) and Section 1115 waiver programs, Katie Becket waivers, and state plan services)
- Supporting the design of and assessing quality measures for an array of health services, including HCBS
- Implementing home-based primary care, integrated care/care coordination, and care delivered via CMS alternative payment models
- Exploring Medicare Advantage plans and other means of providing HCBS for diverse communities
- Conducting surveys, literature reviews, and needs assessments for Administration for Community Living-administered grant programs that provide HCBS for older adults and people with disabilities
- Sharing our deep knowledge of Nuanced HCBS models delivered outside the U.S. Department of Health and Human Services (e.g., programs for home modification through the U.S. Department of Housing and Urban Development) through publications and presentations
Learn more about how RTI is supporting HCBS access and equity.
