Home and Community-Based Services: System-wide Coordination to Improve Care, Hold Down Costs

October 9, 2015

The movement toward home and community-based, long-term services and supports (LTSS) continues to grow, resulting in increased demand for these services. The goal is to help people live in the community independently, yet many barriers to offering HCBS still exist. This briefing will examine the potential of HCBS to reduce health care costs and improve quality of care. It will explore the intersection of HCBS, the broader health care delivery system and Medicaid, which is the largest payer of LTSS.

If you were unable to attend the briefing, here are some key takeaways:  
Anne Montgomery, senior policy analyst, Altarum Institute
Medicaid pays for about 34 percent of long-term care spending and about half of the U.S. population, including the elderly and disabled, will need long-term services and supports (LTSS) at some point, said Anne Montgomery. A number of HCBS waiver authorities exist under Medicaid and as states attempt to create more comprehensive systems, they must wade through specific rules and limitations of these different authorities. While some populations would rather be in a program operating under waiver authority, many states are offering managed LTSS programs as a way to ensure budgetary predictability and to get people off of waiver waiting lists, she added.

Bea-Alise Rector, director of home and community services, Department of Social and Health Services, Washington State
In 2015, Washington State served 84 percent of individuals receiving Medicaid long-term services and supports in their own home and community. According to Bea Rector, if the same number of people served today in Washington State’s LTSS system were served with the same service mix available in 1999, which was 34% community and 66% nursing home, the state would have to have spent $2.7 billion more in taxpayer dollars by now.

Abby Marquand, director of policy research, Paraprofessional Healthcare Institute (PHI)
Family caregivers are providing the bulk of home and community-based services and most are doing it unpaid and with very little support, said Abby Marquand. She also noted that as a result of rebalancing efforts, the number of homecare workers has more than doubled over the past ten years because many more people are being served in their homes and communities instead of institutions. However, wages for this group of workers have been stagnant over the same period of time.

Jean Accius, director of health and LTSS policy, AARP
Findings from the AARP state scorecard on long-term services and supports for older adults indicate that there is variation in LTSS rebalancing across the country. While most states are shifting toward more home and community-based services, the pace of change is slow relative to the increase in the aging of the population, said Jean Accius.

Sarah Dash of the Alliance for Health Reform and Michael Monson of the Centene Corporation will co-moderate the discussion.

Follow the Briefing on Twitter: #HCBS


The event is organized by the nonpartisan Alliance for Health Reform, with support from the Centene Corporation.


Full Transcript (Adobe Acrobat PDF)

Speaker Presentations

Anne Montgomery Presentation (Adobe Acrobat PDF)
Bea Rector Presentation (Adobe Acrobat PDF)
Abby Marquand Presentation (Adobe Acrobat PDF)
Jean Accius Presentation (Adobe Acrobat PDF)

Event Details

Agenda (Adobe Acrobat PDF)
Speaker Biographies (Adobe Acrobat PDF)

Event Resources