MACPAC June report outlines barriers to HCBS access for vulnerable populations
Too often individuals are finding out about the types of home- and community-based services (HCBS) that are available to them when they are in crisis or a moment of immediate need.
Medicaid waiver programs have very complex requirements, and without an advanced understanding of what eligible beneficiaries need to gain access to services, applying and enrolling in Medicaid programs can be even more challenging. These knowledge gaps are often perpetuated by insufficient or hard-to-find information on government websites.
A lack of advanced knowledge about care options through Medicaid and the Children’s Health Insurance Program (CHIP) is one of the many barriers to access for those who are eligible for Medicaid HCBS, according to a recent report from the Medicaid and CHIP Payment and Access Commission (MACPAC). MACPAC is a non-partisan agency that makes policy recommendations to federal and state agencies on a variety of Medicaid and CHIP initiatives.
Increasing access to care is top of mind for the Centers for Medicare & Medicaid Services (CMS) as well. The agency recently closed the comment period on a new proposed rule targeted at reducing barriers to entry into Medicaid and CHIP programs. Among the many goals outlined, the proposed rule promises to promote beneficiary engagement in Medicaid programs, in the hopes of making enrollment and re-enrollment more accessible to eligible members.
Why is Accessing Care So Difficult?
The MACPAC June report to Congress included a comprehensive look at the current state of Medicaid and CHIP payment policies, dual enrollment in Medicare and Medicaid, insurance coverage for those leaving prison and access to HCBS. The final chapter on HCBS access outlined the primary reasons individuals are unable to get the help and services they need to live in their homes and communities, including:
- Low provider availability
- Service gaps
- Lack of knowledge of services available
- Administrative burdens
Despite a growing demand for and appreciation of the benefit of HCBS for those seeking to age in place, state Medicaid offices are not required to provide HCBS to their program members. All states offer HCBS, but the degrees to which they are provided vary by state.
As described in the report, there are simply not enough providers – including direct care workers and support professionals – to meet today’s HCBS demand. This workforce shortage has been exacerbated by historically low pay, though many states are using American Rescue Plan Act (ARPA) funding to increase provider wages.
When it comes to the use of services and potential gaps, it is difficult for state agencies to fill every need of HCBS. Additionally, long waitlists end up encouraging HCBS beneficiaries to seek help elsewhere – states have reported average wait times for services up to 44 months.
Beneficiary knowledge gaps can create challenges, particularly because often different state agencies oversee varying Medicaid waiver programs, each with its own unique set of qualifiers. This may lead to confusion or beneficiaries applying for as many options as possible to increase their chances of entering any Medicaid waiver program.
Finally, state agency workers face cumbersome administrative processes in program management. Administrative burdens weigh heavily on state agencies with limited resources and budgets, and therefore make it more difficult for eligible members to easily enroll in HCBS programs.
Access to care remains a hot button issue for state agencies and beneficiaries alike as Medicaid disenrollments have resumed following the unwinding of the COVID-19 continuous enrollment provision. According to the MACPAC report, the group remains committed to using the next year to identify policies that will help increase access to care across the nation.
