Medicaid home- and community-based services (HCBS) provide vital supports for people with disabilities and older adults that enable them to live safely in their communities of choice. But both the funding and availability of HCBS fall far below its importance, leaving too many people without services to meet their needs. The institutional bias of the Medicaid program guarantees access to nursing home care, but not HCBS, despite the latter being what people want for themselves and for their loved ones.

The optional nature of HCBS funding has led to a panoply of state laws and approaches to HCBS. Far too many callers to our national helpline want HCBS but are trapped on waiting lists or cannot get the specific care they need, leaving them no option but to enter nursing homes or other congregate settings. This is especially troubling during the COVID-19 pandemic, which has demonstrated yet again that congregate settings are not just less preferred by most, but can also be dangerous.

If enacted, the HAA would greatly expand access to HCBS, helping people who need supports to stay in their communities, age in place, and live the lives they choose. The Medicaid program must be made more equitable and better meet the needs of those it serves. We are fully committed to this vision and offer the following suggestions to tweak the HAA to better achieve it.