Home and Community-Based Services

Part of LeadingAge's 2020 Policy Priorities

LeadingAge Advocacy Goals

  • Advance policy that promotes the availability of HCBS across funding streams, including Medicaid, Medicare, Older Americans Act, and Veterans Affairs.
  • Ensure that critical service providers, including adult day services, PACE, and home-based care, have the resources needed to provide high-quality care.
  • Promote federal rulemaking that ensures access and quality HCBS for beneficiaries while minimizing provider burden.
  • Preserve the ability and discretion of states to regulate assisted living.
  • Oppose block grant and per capita cap policies.

LeadingAge members are saying:

The Issue

Home and Community-Based Services (HCBS) continues to grow as an important part of the aging services continuum. While Medicaid continues to be the main public payer for HCBS, other federal funding sources present HCBS providers with new reimbursement opportunities (e.g., Medicare Advantage Supplemental Benefits).

At the federal level, HCBS is considered an optional Medicaid service, allowing states to cap Medicaid HCBS enrollment. Certain federal regulations over time (e.g., the Settings Rule) could also limit which providers can receive Medicaid HCBS reimbursement. State policies also play a major role in the availability of HCBS, such as Medicaid rate setting, managed care, PACE expansions, and waiver development.

Advocacy Action 2020

116th Congress

  • Spousal Impoverishment Protections for Medicaid HCBS: We support the Protecting Married Seniors from Impoverishment Act, which expands permanently the spousal impoverishment protections authorized in section 2404 of the Affordable Care Act and set to expire on May 2020.
  • Adult Day Coverage Under Medicare: We support the Medicare Adult Day Services Act (H.R. 4063) that amends Medicare to cover adult day services.
  • Revise Medicaid Law to Put HCBS (including PACE) on Equal Footing with Nursing Homes.
  • Older Americans Act Reauthorization: We support the reauthorization of the Older Americans Act which includes a broad range of provisions to improve home and community-based services and supports. The Dignity in Aging Act (H.R. 4334) has passed the House.

Executive Branch

  • HCBS Settings Rule: We will monitor implementation of the HCBS Settings Rule at the federal and state levels.
  • HCBS Rulemaking: We will respond to proposed federal rulemaking focused on HCBS and related supports.
  • Medicaid Waiver Activity: We will review and comment upon Medicaid waiver and state plan applications.
  • Veterans Affairs: We will track the implementation of the VA Community Care Networks.
  • Supplemental Services Under Medicare Advantage: We will encourage CMS to continue broadening HCBS availability in Medicare Advantage and work with plans on implementation.
  • LTSS Expenditure Reports: We encourage CMS to resume the publication of annual LTSS expenditure reports.

Actions You Can Take Now

  • Visit the Advocacy Action Center and help your members of Congress understand how policies they make impact Home and Community Based Services.
  • Host a Coffee Chat with Congress in your community to help your members of Congress understand how policies impact HCBS providers and residents.
  • Mobilize with the Advocacy Champions toolkit and let your representatives and senators know you support more opportunities to create and sustain home and community-based services.

Additional Resources