Decisions about funding, service provision and policy when it comes to Medicaid home- and community-based services may not always reflect the needs of the people it affects most, particularly older adults of color, experts maintain.
A research pilot project set out to change that.
The nonprofit group Community Catalyst partnered with the LeadingAge LTSS Center @UMass Boston to test some HCBS quality measures with the help of those who actually use the services. The result is a new report, “Centering Perspectives of Dually Eligible Older Adults of Color,” that the authors hope will begin to inform local, state and national policies about priorities in HCBS for older adults, to ensure that quality services are delivered — and received.
Medicaid HCBS program approaches to quality measurement are highly variable and, for the most part, not reflective of the needs of those who use those programs, according to the authors. Community Catalyst and the LeadingAge LTSS Center partnered with California community organizations in a pilot program to co-create a set of HCBS quality measures.
The project engaged a small group of dually eligible older adults of color to look at Medicaid HCBS measurements and identify what the individuals prioritize in quality and access. The project specifically focused on the Golden State, where 1.7 million people are dually eligible for Medicare and Medi-Cal, the state’s Medicaid program; 66% of those individuals are from communities of color.
Through the project, a 10-member advisory committee, with representatives from community groups and dually eligible older adults of color, was established to evaluate and prioritize dimensions of quality and develop survey questions to try to best address what matters most to them.
The pilot program also involved reviewing national and state surveys, as well as gathering focus group feedback on test survey questions.
The process identified what mattered most to HCBS recipients and fell into three areas:
- Structure and access — finding care, ensuring language and cultural compliance, and navigating care management and coordination.
- Process — person-centered care.
- Outcomes — problems with care, discrimination when receiving care, post-acute care
Other important areas identified as needing further exploration included control of care, transportation, staff consistency, service plan development, community access and elder abuse.
The project was just the first step in the process of co-creating a set of national HCBS quality measures. The findings, the report authors said, can begin to inform local, state and national policy about what should be prioritized in HCBS for older adults to ensure high-quality services are delivered and received.
Results of the study were published as a proposed federal rule establishing mandatory quality measures for HCBS, among other things, is under final review by the White House Office of Management and Budget. The Centers for Medicare & Medicare Services has indicated that it plans to issue a final Medicaid Access Rule by April.
When the rule was proposed in July, senior living industry advocates told McKnight’s Senior Living that the proposed quality measures had the potential to burden assisted living providers financially and administratively. The organizations made a case for additional funding to implement the measures while lobbying to keep as much related oversight as possible at the state level.
