What’s Next in Home and Community-Based Services?

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Home and community-based services (HCBS) is a subset of long-term services and supports (LTSS) that allows patients to receive health services in their home or a local setting rather than a typically higher-cost institutional setting. Offerings include intensive, round-the-clock care through more wrap-around services such as caregiver support, home-delivered meals, and employment supports. About 2 million people received home and community-based services in 2020. Traditionally, Medicaid is the largest payer of HCBS in the country, but recently Congress has discussed dedicating more federal funding, including through American Rescue Plan Act and the House-passed Build Back Better.

During this session, panelists provided an overview of home and community-based services, including populations receiving these services, current enrollment numbers, workforce challenges, benefits of HCBS, and barriers to caring for complex populations. Panelists also spoke to recent federal policy measures taken to bolster HCBS as well as potential long-term policy levers to better improve this model.

For more information on LTSS more broadly, please see the Alliance’s November 2019 event: Long-Term Care: Where Are We and What’s Next?.


  • Hany Abdelaal, D.O., President, Health Plans, VNS Health
  • Dennis Heaphy, M.Div., M.Ed., MPH, Health Justice Policy Analyst, Researcher Disability Policy Consortium
  • Shannon McCracken, Vice President of Government Relations, American Network of Community Options and Resources (ANCOR)
  • Damon Terzaghi, MSA, Senior Director of LTSS Policy, ADvancing States
  • Kristal Vardaman, Ph.D., MSPH, Director of Medicaid Policy & Programs, Aurrera Health Group (moderator)

Key Event Takeaways:

  1. It is essential that HCBS care providers receive sufficient funding to provide individualized, variable, and person-directed services based on individual need and preference.
  2. Lack of integration of care for the dual-eligible population continues to serve as a roadblock for effective home- and community-based care and for pursuing health equity at large.
  3. There is a shortage in the workforce of direct support professionals to provide these services. This is due to stagnant reimbursement rates and inability to compete with other industries – an issue that has only worsened in the wake of COVID-19.
  4. Section 1915(c) of the Social Security Act allows for flexible state funding for HCBS and targeting of specific populations, resulting in variance between states and personal outcomes.

This event was made possible with support from Arnold Ventures.