Worker Shortages, Waiting List Inaccuracies Complicate HCBS Programs

McKnight’s Senior Living | By Kimberly Bonvissuto
 
The COVID-19 pandemic put a spotlight on fundamental, long-term challenges for state Medicaid home- and community-based services programs, but it also provided opportunities for change, according to a new Kaiser Family Foundation issue brief.
 
In 2021, states reported offering 255 waivers under Section 1915(c), the largest source of HCBS spending and the type through which assisted living operators often provide services, with an average of five waivers per state. The data are based on the 20th KFF survey of state Medicaid HCBS officials in all 50 states and Washington, DC, between April and September. 

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A Closer Look At The Millions Of People On HCBS Waiting Lists

Home Health Care News | By Patrick Filbin
 
More than half a million people across the U.S. were on state waiting lists for home- and community-based services (HCBS) in 2021.
 
But the number of states that have a waiting list for people who are in need of HCBS is the lowest it’s been since 2016 at 37.
 
However, HCBS waiting lists are often incomplete and sometimes inaccurate, making it difficult to quantify the unmet need for the services financed through Medicaid waivers.
 
In 2021, about 656,000 people were on HCBS waiting lists, according to the Kaiser Family Foundation (KFF). That’s lower than the nearly 820,000 individuals that were on Medicaid waitlists for HCBS in 2018.
 
Home- and community-based services are a way to fill gaps in care for seniors with complex medical conditions. Medicaid is often the main source of coverage for long-term services and supports (LTSS).
 
There are well over 2 million individuals receiving HCBS services, but the way waiting lists are calculated can be an unscientific process that can both overstate and understate unmet needs, according to KFF.
 
For example, not all states screen for Medicaid eligibility before adding people to HCBS waiting lists. That can inflate the number on a waiting list by adding people who may never be eligible for services.
 
In its most recent analysis, KFF found that over half of people on HCBS waiting lists lived in states that did not screen people on waiting lists for eligibility.
 
The only HCBS that states are required to cover is home health care, but states can choose to cover personal care and other similar services.
 
Waiting lists can also understate need. States choose which populations they serve through the Medicaid waiver and what resources they will commit.
 
People may need services, but if the state doesn’t offer them — or doesn’t offer them to people over 65, for example — those individuals would not appear on a waiting list.
 
“Even though HCBS waiting lists are an imperfect measure of unmet need, there are no other measures available,” KFF wrote in its summary. “Therefore, waiting lists remain a source of concern to policymakers, and proposals to eliminate them have been put forth by both Republicans and Democrats.”
 
Takeaways from KFF analysis…

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CMS Pressures States to Adhere to Upcoming HCBS Rule Deadline

McKnight’s Home Care | By Liza Berger

[Last] Thursday [was] the cut-off for states to submit corrective action plans (CAPs) for their home- and community-based services (HCBS) programs in advance of the March 17 HCBS regulatory deadline. But the Centers for Medicare & Medicaid Services is concerned that states are dragging their heels on the CAPs.

“Today’s conversation is in the name of information sharing, technical assistance, reiterating expectations that we are a partner in adhering to the settings regulation, and yet we’re quite serious that it needs to have meaning and beneficiaries need to be able to see their lives reflected in the in the words in the regulation,” Melissa Harris, deputy director for the Disabled and Elderly Health Programs Group, said earlier this month, according to the Inside Health Policy news outlet.

The warning comes as HCBS stakeholders have voiced concerns that a majority of providers are turning away referrals because of limited staff capacity, and the workforce crisis is putting a severe strain on resources. CMS officials have been adamant that workforce shortages are not a justification for not meeting basic civil right requirements such as access to food and freedom to have visitors.

If states anticipate they will be unable to come into compliance with the final rule by March 17, they have until Dec. 1 to submit CAPs, CMS has said. States’ CAPs should include details on which criteria they need more time to complete — excluding criteria that protect basic civil and constitutional rights.

In May, CMS issued a recalibrated strategy to help states comply with the HCBS final rule and the March 17 deadline.

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More than 90% of COVID Deaths Occurring Among Elderly Adults: CDC

ABC News | Mary Kekatos

Older people have always been known to be one of the groups at highest risk of death from COVID-19, but they now make up a larger share than ever before.

As of the week ending Nov. 19, Americans aged 65 and older make up 92% of all deaths from the virus, according to data from the Centers for Disease Control and Prevention.

It's the first time senior citizens have made up more than nine out of 10 deaths since the pandemic began and a drastic increase from the roughly 58% of deaths they made up in summer 2021, an ABC News analysis shows.

An infectious disease expert told ABC News the data showcases the lack of boosters received by the older population and how the impact of the disease is hitting the most vulnerable as protection mounts in the population.

"The bottom line is that age is the most powerful risk factor for COVID deaths and we've known that all along," Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco, told ABC News. "At this point in the pandemic, it's not enough to just get a vaccine series. So, what it reflects is the failure of the older age group to get boosters."

As of Nov. 24, just one-third of people aged 65 and older have received the bivalent boosters, CDC data shows.

The updated booster specifically protects against the omicron subvariants BA.4 and BA.5, currently making up about 20% of infections in the U.S.

While this percentage is higher than most other age groups, Chin-Hong said it's still quite low for a group at high risk of severe illness and death.

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