ARLINGTON, VA - ADvancing States and our partners in the American Rescue Plan Act (ARPA) home and community-based services (HCBS) Technical Assistance Collective (TA Collective) are proud to release a report from the HCBS Sustainability Summit. The TA Collective brought together 18 HCBS thought leaders — comprised of state officials, home and community-based services (HCBS) advocacy leaders, people with lived experience and their caregivers — for a day-long meeting in October 2023 to discuss the challenges facing the HCBS system and approaches to building on the successes of the ARPA HCBS initiatives. We are grateful to The John A. Hartford Foundation, the Care for all with Respect and Equity (CARE) Fund, The SCAN Foundation, and the Milbank Memorial Fund for their support in making the Summit possible.
The ARPA infusion of dollars into HCBS provided an historic opportunity to try bold, new approaches to supporting people in their homes and communities. While work has been done nationally to highlight ideas and methods for improving HCBS and establishing more flexible policy, the current structure of Medicaid, and HCBS in particular, often serves as a barrier to modernization. The institutional bias within Medicaid poses an ongoing challenge to the true realization of HCBS as a viable option for all.
Summit attendees offered an abundance of thoughtful considerations for improving, expanding, and enhancing HCBS, focused on the broader systems changes necessary for advancing HCBS guided by these principles:
- Our nation’s LTSS system must prioritize the preference of most people in the U.S. to live in HCBS settings.
- People with lived experience must have a voice in efforts around HCBS.
- HCBS must be the first option offered to individuals, and the system must have capacity to serve all individuals who choose it.
- Operating HCBS must be made simpler and more understandable for all partners in the system.
- HCBS must be available to all, regardless of how they communicate, their backgrounds, and their cultures.
- Congress, CMS and states must create a space for new ideas and sharing across the country.
The HCBS system is facing more challenges than ever before. Our hope is that this report — and the strategies contained therein — serves as a roadmap for future direction and investments in our HCBS system.
About the ARPA HCBS Technical Assistance Collective
The ARPA HCBS Technical Assistance Collective brings together four organizations with deep expertise in HCBS systems: ADvancing States, Halperin Health Policy Solutions, the National Association of State Directors of Developmental Disability Services (NASDDDS), Riverstone Health Advisors, as well as Brian Burwell. The TA Collective’s mission is to support states as they strive to maximize the impact of the unprecedented HCBS funding available under the American Plan Rescue Act. The TA Collective has been working with states on their ARPA HCBS initiatives since October 2021 and has delivered project management support, direct technical assistance, and shared learning opportunities to states.
ADvancing States (www.advancingstates.org) represents the nation’s 56 state and territorial agencies on aging and disabilities and long-term services and supports directors. ADvancing States supports visionary leadership, the advancement of systems innovation and the articulation of national policies that support long-term services and supports for older adults and people with disabilities and their caregivers.
Halperin Health Policy Solutions (www.halperinhealthpolicysolutions.com) is an independent consulting firm that provides state and federal government agencies, non-profits, and provider organizations with direct assistance related to healthcare and long-term services and supports (LTSS) access and coverage issues for lower-income older adults and persons with disabilities.
NASDDDS (www.nasddds.org) assists member state agencies in building person-centered and culturally and linguistically appropriate systems of services and supports for people with intellectual and developmental disabilities and their families.
Riverstone Health Advisors (www.riverstonehealthadvisors.com) consults to state and federal agencies, health plans, vendors, and providers as they strive for success in government healthcare programs, including Medicaid home and community based services (HCBS) and other Medicaid long-term services and supports (LTSS) programs, Medicaid managed care, and Veterans’ healthcare, among other programs.
Brian Burwell is an independent contractor and nationally recognized expert on HCBS policies and programs. He served as a Commissioner on the Medicaid and CHIP Payment and Access Commission for six years. His career has been focused on Medicaid policy for older persons and persons with significant disabilities.