two women talking with masks on

A whole government approach is needed to bring home- and community-based services (HCBS) equitably to seniors and the disabled, a top adviser to the U.S. Department of Health and Human Services said Wednesday. 

Alison Barkhoff, acting administrator and assistant secretary for Aging, made that assessment during a webinar sponsored by nonprofit healthcare consultants Altarum Institute. Barkhoff said the Centers for Medicare and Medicaid Services’ Money Follows the Person program is a great example of an HCBS program that requires multi-agency coordination. The federal Medicaid program supports state efforts to rebalance their long-term services and supports, and seeks to increase the use of HCBS and reduce the use of institutionally based services. 

Alison Barkhoff

“We know that Money Follows the Person is about access to services, but one of the biggest barriers is lack of access to integrated, affordable, accessible housing,” Barkhoff said. “We have partnered with the U.S. Department of Housing and Urban Development to match up existing housing resources with people who are transitioning (into the community).”

Program improvements needed 

Tyree Brown — a quadriplegic — said on the webinar that this particular program helped her return home after several months in skilled nursing following a car accident five years ago. But Brown said the program required her to wait six months for the installation of ramps and slides to accommodate her wheelchair.

“If I didn’t have strong brothers, a strong father and strong neighbors to lift me and get me up and down the stairs, I don’t know what I would have done,” she said.

Barkhoff said the Money Follows the Person program could have done a better job providing for home modifications more quickly or could have matched Brown to housing better suited to her needs.

Funding plans 

The Biden administration’s COVID-19 relief package provided a $12.7 billion increase to states for HCBS. That money began flowing to states in early April. Additionally, the administration wants to pump $400 billion dollars into community-based services as part of its American Jobs Plan. That money would provide better wages and training to caregivers and expand non-institutional programs.

Barkhoff said the pandemic shone a spotlight on the inequality of the nation’s support system for seniors and the disabled, pointing to the high COVID-19 death rate among nursing home residents. She called access to quality care a civil right and said the administration is working aggressively to ensure that all groups, including people of color and the LGBTQ, receive equitable community-based care.