Medicaid HCBS programs shift funding allocations as public health emergency flexibilities end
Family caregivers have always been the backbone of home- and community-based services (HCBS), stepping up to provide for loved ones so they can remain right where they want to be – at home. In fact, in recent years, their willingness to sacrifice and provide care has been vital to millions of individuals who may not have received the support and services they need otherwise.
Healthcare worker and provider shortages continue to impact Medicaid HCBS programs and participants, and waitlists are growing increasingly longer for state-sponsored care. Today, an estimated 65.7 million people care for loved ones living at home – roughly 29 percent of the adult population in the United States.
Thanks to some pandemic-era flexibilities and enhanced support from the federal government, many states were able to increase payments to family members and/or guardians caring for individuals eligible for Medicaid HCBS from March 2020 until this year. But unfortunately, family caregivers will undoubtedly feel the impact of the unwinding of the public health emergency (PHE). A recent 50-state survey conducted by the Kaiser Family Foundation found:
- 11 states will no longer allow spouses or children to be paid as caregivers for HCBS program participants.
- Five states are eliminating a provision that recognizes family members as providers who can receive payment from the state.
- Many states continuing to offer payment to family caregivers are eyeing spending caps on waiver program participation, which will reduce the number of caregivers that can get paid.
According to the survey, states are more likely to pay family caregivers who are not legally responsible for the individuals receiving care, and the most common waiver programs to offer family caregiver payments for individuals 65 and older living with intellectual and developmental disabilities. Additionally, relatives are more likely to be on the state payroll if they are caring for someone enrolled in a Medicaid waiver program. This may limit compensation opportunities as waiver program spots are often restricted.
As the desire to keep aging and disabled populations out of institutional settings continues to grow, individuals are becoming increasingly reliant on loved ones to safely remain in their homes and communities. Whether there are payments or not, most states do provide some assistance, though it often goes unused, according to the KFF survey. Most states provide respite care, training and counseling for relatives caring for vulnerable populations. Additionally, advocacy groups offer assistance to family caregivers in finding the support services they need to effectively care for loved ones.
At FEI Systems, we applaud the work of family caregivers and support solutions that help vulnerable populations thrive in the locations they choose to live.
