Pandemic-era Medicaid flexibilities allowing augmented access to home and community-based services through 1115 and 1915 authorities have or will be sunsetting. While states had options to make many of these flexibilities permanent, many states have selected to not seek permanent authority to continue these flexibilities. KFF released an issue brief on September 19 outlining a number of findings from a recent survey and stressing how these changes could affect the already dire workforce shortage, including:

• 49 states elected to allow for virtual eligibility and care planning visits; 26 states have or will maintain this flexibility, leaving 23 states to terminate this option.
• 21 states are reverting to service utilization limits as outlined in their approved waivers.
• 19 states are returning to pre-pandemic prior authorization requirements.
• 17 states have or will be terminating payments to family caregivers or legally responsible parties to be paid for Medicaid reimbursable services.