Howard Gleckman

The $1.9 trillion coronavirus relief package passed by the U.S. House of Representatives on Saturday includes billions of dollars in new funding for government long-term services and supports for frail older adults and young people with disabilities. Many long-term care experts, however, worry that the bill’s most far-reaching change may be a temporary funding increase for Medicaid home- and community-based services that exclude nursing care.

Although the 7.35% bump to Medicaid LTSS funding is temporary, President Biden and congressional Democrats undoubtedly will want to make it permanent, noted a Forbes analysis last week. Further, even if the increase is only temporary, it is likely to accelerate an ongoing shift to HCBS that began long before the pandemic.

That overall approach also has been endorsed in a new report from research and advisory firm ATI Advisory. The firm recommends permanently increasing the federal match for Medicaid HCBS, as well as other broader reforms such as setting national minimum eligibility standards for Medicaid HCBS participants, setting a minimum personal needs allowance for those living at home, and adjusting state HCBS waiting lists to focus on level of need. Such reforms also could apply to the assisted living communities that provide HCBS to residents via Medicaid waivers.

“Like the House Democrats’ approach, ATI initially would use the carrot of new financial incentives to encourage states to expand their HCBS programs rather than the stick of forcing them to scale back nursing home benefits,” wrote Forbes Senior Contributor Howard Gleckman, a senior fellow at The Urban Institute. “This approach may not have much impact in some nursing home heavy states such as Louisiana but it could boost Medicaid home care in much of the nation.”