The Centers for Medicare & Medicaid Services (CMS) launched a new “one-stop shop” for state Medicaid agencies and stakeholders on Medicaid.gov to advance transparency and innovation for home and community-based services. Home and community-based services allow people enrolled in Medicaid to receive services and supports in a preferred setting outside of an institution, such as in their own home. Through this new webpage, state Medicaid agencies and stakeholders can access information about states’ plans to enhance, expand, and strengthen home and community-based services across the country using new Medicaid funding made available by the American Rescue Plan Act of 2021 (ARP).
Additionally, CMS is approving today a new Medicaid section 1115 demonstration in Alabama, entitled the “Community Waiver Program,” to operate concurrently with a home and community-based services 1915(c) waiver. This new opportunity in the state’s Medicaid program will increase access to home and community-based services, and allow the state to meet the needs of additional individuals who prefer to get long-term care services and supports in their home or community rather than an institutional setting.
“One-stop Shop” for Plans to Enhance, Expand, & Strengthen Home and Community-based Services
To encourage states to expand home and community-based services and strengthen their programs, the Biden-Harris Administration implemented a funding increase established by the ARP. The ARP provided states with a temporary 10 percentage point increase in federal Medicaid funding for certain Medicaid home and community-based services from April 1, 2021 through March 31, 2022, if they meet certain requirements. As the COVID-19 pandemic continues, the additional federal funding made available under the ARP allows those enrolled in Medicaid who need long-term services and supports to receive the assistance required to reside in the setting of their choice.
“The Biden-Harris Administration recognizes the value and dignity that come with access to home and community-based services,” said HHS Secretary Xavier Becerra. “Thanks to the American Rescue Plan, we can support states working to expand access to home and community-based services for Medicaid beneficiaries. With the launch of this new online hub, we’re making it easy for states to exchange ideas on how best to care for their residents.”
“The ability to access health care at home or in the community is essential for many low-income families, older adults, and individuals with disabilities who rely on Medicaid services — especially during this unprecedented public health emergency,” said CMS Administrator Chiquita Brooks-LaSure. “Thanks to the American Rescue Plan, CMS is providing state Medicaid agencies with the tools and funding needed to expand this important care. We welcome the opportunity to work with states to expand home and community-based services to meet the needs of their communities.”
The announcement issued today reinforces CMS’s commitment to assist states in response to the public health emergency. State administrators and stakeholders are encouraged to visit Medicaid.gov to view states’ programs and activities to identify innovative approaches that can support home and community-based services and improve capacity building and infrastructure in their area by drawing inspiration from other states.
For example, some states are delivering vaccines to people with disabilities and older adults through mobile COVID-19 vaccination programs. Other states are focusing on the potential of home and community-based services to help people with Medicaid coverage receive care outside a skilled nursing facility after a hospitalization, when aligned with the beneficiary’s goals. Other activities may include expanding and implementing new, community-based behavioral health crisis response services, ensuring that a qualified provider with training quickly and properly responds to mental health and substance use-related crisis situations. Many states are also providing recruitment and retention bonuses and increasing pay for direct support professionals, as well as implementing new training programs and other strategies to strengthen the direct support workforce. These actions allow Medicaid enrollees to receive care in the comfort of their own home or in a preferred community setting.
To view the home and community-based services webpage with states’ ARP section 9817 spending plans and narratives, letters issued to states on their spending plans and narratives, and other important information related to the implementation of ARP section 9817, please visit https://www.medicaid.gov/medicaid/home-community-based-services/guidance/strengthening-and-investing-home-and-community-based-services-for-medicaid-beneficiaries-american-rescue-plan-act-of-2021-section-9817-spending-plans-and-narratives/index.html.
For additional information on ARP funding for home and community-based services, see the guidance that CMS issued to states via a State Medicaid Director Letter in May of this year.
New Demonstration for Home and Community-based Services in Alabama
The Biden-Harris Administration is proud to help states that have long been at work to advance home and community-based services. Separate from the new website launched today, CMS has approved Alabama’s earlier application for a section 1115 demonstration, entitled “Community Waiver Program.” The 1115 demonstration will operate concurrently with a home and community-based services 1915(c) waiver in Alabama, a new opportunity in the state’s Medicaid program to meet the needs of additional individuals who prefer to get long-term care services and supports in their home or community rather than an institutional setting. Together, Alabama’s 1115 demonstration and 1915(c) waiver will increase access to home and community-based services for many Alabamans who are currently on a waiting list.
The state will now be able to redesign its home and community-based services delivery system to address concerns, such as long waiting lists, high use of residential services and out-of-home placements, and low integrated community employment rates among its residents. CMS will also provide the authority needed for Alabama to create a new program that supports individuals with intellectual disabilities who choose to work, live with family, or live independently.
“It is important we find ways to collaborate to help Alabamians in need, particularly those with intellectual disabilities. My Administration is pleased to offer the Community Waiver Program, which focuses on serving individuals with intellectual disabilities before they are in crisis,” said Alabama Governor Kay Ivey. “The partnership between the Alabama Department of Mental Health and the Alabama Medicaid Agency will help integrate these individuals in the community, giving them a better chance to develop skills to work and live independently.”
To view Alabama’s section 1115 demonstration approval and the new 1915(c) waiver, visit: https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/101016.