End Of Pandemic-Era Policies Could Hit HCBS Utilization Hard

The end of certain pandemic-era policies could have dire effects on family caregivers and home- and community-based services (HCBS) enrollees.

Family caregivers played a key role in supporting the estimated 4 million people who utilized Medicaid-based HCBS during the pandemic.

Several states used pandemic-era authorities to pay family caregivers in order to maintain services when the workforce shortage in home-based care was at its worst.


Now that the public health emergency (PHE) has ended, several states are ending those payments to family caregivers — and reversing other policies that were put in place during the pandemic — which could complicate ongoing workforce shortages and create new challenges for those that depend on HCBS.

In a 50-state survey of state Medicaid HCBS officials conducted between May and August of 2023, Kaiser Family Foundation researchers found that several of these provisions and policies could be going away for good.

For example, virtual evaluations of people’s eligibility and care needs will end in 23 states; increased utilization limits on existing services will end in 21 states; and prior authorization requirements will be reinstated in 19 states.

Source: KFF

Prior authorization requirements may make it harder for Medicaid enrollees to access HCBS.

“Personal care may be provided through waivers, a Medicaid state plan or a combination of both,” KFF wrote. “Waiver services tend to encompass a wider range of benefits than the state plan benefit, but waivers are usually restricted to specific groups of Medicaid enrollees based on geographic region, income, or type of disability — and are often only available to a limited number of people, resulting in waiting lists.”

Nine states will no longer pay legally responsible caregivers – through waivers – to take care of individuals with intellectual and developmental disabilities.

Seven states will no longer pay caregivers responsible for seniors with physical disabilities.

Although most states told KFF that they plan to make PHE changes permanent, 23 states will stop evaluating eligibility virtually, two states will reduce financial eligibility and three states will reduce functional eligibility.

“Concurrently, 21 states will reinstate utilization limits and 19 states will reinstate prior authorization,” KFF reported. “Some of those changes will reduce the number of people who are eligible for HCBS or reduce the amount of HCBS eligible enrollees may use.

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