More Than Half a
Million People in the U.S. Are On Waiting Lists for Medicaid Home- and
Community-Based Services, But Waiting Lists Can Both Overstate and
Understate Unmet Need
Other Findings From Our
50-State Survey of Medicaid HCBS Programs Focus on How States Are
Responding to Chronic Workforce Shortages That Were Exacerbated by the
Pandemic
About 656,000 people
across the country were on state waiting lists for home and
community-based services financed through Medicaid waivers in 2021, finds
a new KFF
analysis. But such waiting lists are an incomplete and often
inaccurate measure that can both overstate and understate unmet need.
The data about waiting
lists are among the latest findings from the 20th KFF survey of state
officials administering Medicaid HCBS programs in all 50 states and
Washington DC.
Waiting lists can sometimes overstate the need for services because not
all states screen for Medicaid eligibility before adding people to their
lists, which inflates the numbers with people who may never be eligible
for services. In all years since 2016, over half of people on HCBS
waiting lists lived in states that did not screen people on waiting lists
for eligibility, the new analysis found. This also is a key reason that
waiting lists are not comparable across states.
Waiting lists can also understate need. They reflect the populations a
state chooses to serve, as well as the resources it commits. In many
cases, people may need additional services, but because the state doesn’t
offer them—or doesn’t offer them to specific populations, such as people
ages 65 and older—they would not appear on a waiting list.
HCBS waiting lists
remain a source of concern to policymakers and proposals to eliminate
them have been put forth by both Republicans and Democrats.
Many of the other findings from the 50-state survey focus on chronic
workforce shortages that were exacerbated by the COVID-19 pandemic and
are the biggest challenges facing state Medicaid HCBS programs. Key
takeaways from that
analysis include:
- Amid
the pandemic, HCBS workforce shortages have contributed to provider
closures. Most states (44) reported a permanent closure of at least
one Medicaid HCBS provider during the pandemic, up from 30 states in
2021.
- Almost
all states (48) responded to the workforce crisis by increasing HCBS
provider payment rates. States also increased self-directed and
family caregiving opportunities for HCBS beneficiaries. All states
offer at least one HCBS program with the option for enrollees to
self-direct their services. Forty-eight states allow legally
responsible relatives to be paid caregivers, up from 36 states in
2020.
- When
asked how they used temporary funding from the American Rescue Plan
Act of 2021, over two-thirds of states (35) reported initiatives
with high start-up costs that were generally time-limited to avoid
higher ongoing costs after the enhanced federal funding ended. Some
of the most common initiatives included offering providers bonuses
or incentive payments to stay on, developing or expanding worker training
or certification programs, and upgrading IT systems.
The full analyses of the
survey findings are available here:
For more data and
analyses about Medicaid HCBS, visit
kff.org.
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