State Policies Make Home Care Harder to Access

Home care has been long touted as the more cost-effective alternative to assisted living and nursing home care, for both seniors and governments. However, some states are making it harder for seniors to access this less-expensive alternative, and it’s costing them big money. 

Two recent audit reports from Louisiana and Georgia show states are dragging their feet on policies to make home care easier to access than nursing home care.

In Louisiana, residents awaiting state waivers for Home and Community-Based Services (HCBS) may be waiting longer than the rest of the country, says local KTBS.


A report by the Louisiana Legislative Auditor’s Office, issued April 29, shows that because the demand for waivers exceeds the numbers of allocated slots, there were 54,677 applicants waiting for HCBS waiver services as of October 2014.

Of these wait-listed applicants, about 66% (35,857) are waiting for the Community Choices Waiver, which is just one of six HCBS waivers that provide long-term care to people who are elderly or who have developmental or physical disabilities. 

To receive this waiver, the average wait time is about 4.35 years, according to the Legislative Auditor’s Office report. 


This backlog is not only affecting Louisiana’s aging population, but it’s costing the state more because many seniors who cannot receive the waiver services are being pushed toward more costly care settings such as assisted living and nursing facilities, when they might not even need those higher levels of care, said Mary Alice Rountree, executive director of the Caddo Council on Aging based in Shreveport. 

“We know there’s a lot of seniors living in nursing homes that didn’t need that 24/7 [care],” Rountree said to KTBS. “But remember that assisted living is not paid for by Medicaid, and so people at home that were needing just that little bit of care had to jump over that assisted living area of just a little bit of help, but still living independently, into full-time nursing homes.” 

When comparing the costs between HCBS and facility-based care in Louisiana, HCBS wins out as the far cheaper option. 

The average cost for HCBS programs per person ranged from approximately $21 – $135 per day, while nursing facility rates ranged from $139 – $187 per day , according to the audit report.

In Georgia, nursing home stays cost Medicaid almost four times as much per year than HCBS, according to a review by the Georgia Department of Audits and Accounts released earlier this month. 

The follow-up review found that “it remains easier to obtain a nursing home bed than home and community based services (HCBS), that services are still not targeted to those most in need.”

Georgia’s Medicaid Waiver includes two programs that provide an array of services to elderly and disabled participants: Community Care Services Program (CCSP) and Service Options Using Resources in Community Environments (SOURCE).

In fiscal year 2014, CCSP cost $160.9 million and SOURCE $266.3 million, according to the audit review, which indicated the federal government paid approximately 65% of waiver costs, with the state funding totaling $148.6 million. Combined, the two programs served approximately 30,000 individuals. 

One of the main highlights of the audit revealed that while spending on these programs increased between federal fiscal years (FFY) 2011 and 2013, utilization among participants declined. 

In FFY 2013, spending on CCSP and SOURCE was up 18.9% to approximately $400.6 million, compared to $336.9 million in FFY 2011. Meanwhile, during this period, total days of the programs’ service declined roughly 3.7%.

To address the awareness and accessibility of HCBS, Georgia’s Department of Community Health and the Department of Human Services’ Division of Aging have taken steps to include statewide marketing of HCBS programs, the audit review said. 

“However, it is unclear if those admitted to nursing homes are aware of potential HCBS options,” states the review.

Even so, the wait list for waivers is long and winding. Regarding accessibility, 100 slots were added to CCSP since the original audit, but the program has a waiting list that averages approximately 1,500.

“Those in need of immediate long-term support services can generally receive them more quickly from a nursing home,” the audit review states. 

Written by Jason Oliva

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