HCBS waiting lists may give an unclear picture of need
More than half a million people sit on waiting lists for home and community-based services (HCBS) today – some have been waiting for more than five years. This is unacceptable, but the complex underlying causes mean there is no easy solution to bringing services to people faster.
A recent study by the Kaiser Family Foundation (KFF) analyzed a variety of factors concerning waiting lists for HCBS from 2016 to 2021 to determine what, if anything, can be learned about unmet need. What they found is that while the numbers may be alarming, the story they tell at first glance is incomplete.
When comparing HCBS waiting lists across states, it may be tempting to attribute their length solely to the needs (or lack thereof) in a particular state. But the KFF report cautions against this. On one hand, these registries may overstate need because many states do not screen waiver eligibility before placing a person on the list. In fact, more than half the people on waiting lists may not be eligible for services.
On the other hand, the lists may understate need because they reflect only the populations a state serves with its waiver programs. For example, some states only offer HCBS waiver programs for those aged 65 and older. Thus, younger populations are not captured on the waiting list.
According to the report, other factors can help provide a clearer picture of the true amount of need. For example, pandemic-related workforce shortages simultaneously contribute to and create barriers to reducing Medicaid HCBS waitlists across the country. The 50-state survey found that workforce shortages during the pandemic forced HCBS provider closures in 44 states, affecting not only elder care facilities, adult day cares or group homes, but also reducing the availability of professionals that can provide home-based care.
As with many things since 2020, the implications of these findings are bittersweet. The length of waiting lists coupled with workforce shortages have pushed overall average wait times to 45 months. And unfortunately, some will wait this long only to find out they are ineligible to receive services at all. The silver lining is most states offer a variety of HCBS in their state plans (no waiver needed) and many of those on waitlists for one service receive others in the meantime. Additionally, the workforce shortage has encouraged states to increase compensation for providers and to expand self-directed and family caregiving opportunities for HCBS beneficiaries. Several states have also had success in drastically shortening, or eliminating, their waiting lists by implementing new screenings prior to waitlist placement.
At FEI, we are here to help. We can’t let eligible members wait months, or even years, for vital services. Our Blue Compass case management solution for LTSS assists with the entire lifecycle of HCBS waiver and program management. Our platform streamlines operations to ease the burden on agencies providing services and can assist with waitlist management, allowing for more people to get what they need faster.
