Lack of Federal Strategy Threatens Home Health Access

Federal agencies that fund home- and community-based services (HCBS) don’t work together well, undercutting seniors’ ability to age in their own homes, according to a government report released Wednesday. A federal strategy is needed to increase coordination and improve the availability and effectiveness of HCBS programs, the report states.

Five federal agencies provide funding for HCBS initiatives: the Administration on Aging (AoA), the Centers for Medicare & Medicaid Services (CMS), and the Departments of Housing and Urban Development (HUD), Transportation (DOT) and Agriculture (USDA). They facilitate meal delivery, affordable housing, transportation, in-home services and related supports, which seniors often require in order to live at home rather than enter a long-term care facility or similar setting, the report from the Government Accountability Office notes.

The problem? These agencies do not as a rule collaborate, and in fact compete with each other for dollars in some cases. As a result, policies and procedures are not streamlined and may actually be at cross-purposes.


For example, some CMS programs incentive states to reduce the number of people in institutional long-term care. But Congress eliminated funding for capital advances under HUD’s 202 affordable housing program, constraining the supply of housing available to low-income seniors.

“One implication of these simultaneous developments is that, if there is no housing available, older adults may be unable to receive services unless they reside in an institutional setting,” the GAO report states.

A federal strategy for cross-agency coordination is needed and should be facilitated by the Department of Health and Human Services (HHS), the GAO recommends. This is especially important because federal funding for HCBS may be insufficient for meeting demand, putting even more pressure on agencies to utilize existing resources “effectively and efficiently.”


HHS concurred with the recommendation.

To develop its report, GAO visited three localities—in San Francisco, Atlanta and a Maryland county—to observe how HCBS programs are run and interview stakeholders on the ground. GAO also reviewed federal laws and other documents and interviewed federal officials.

Access the complete report here.

Written by Tim Mullaney

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