CMS Releases Guidance Emphasizing More Tools, Funding To Support HCBS

The U.S. Centers for Medicare & Medicaid Services (CMS) is again taking steps to increase access to Medicaid home- and community-based services (HCBS).

On Tuesday, the agency provided further guidance around how states can better support HCBS programs, which are both popular and sometimes hard to navigate.

“For too long, American families have struggled to find and afford reliable high-quality care that enables their loved ones to live independently,” U.S. Department for Health and Human Services Secretary Xavier Becerra said in a statement. “Some people are forced to forgo their careers and stay home to care for a family member, and many caregivers struggle to make living wages. Thanks to President Biden and the American Rescue Plan, that changes today.”


The Biden-Harris Administration has been an ardent supporter of HCBS access throughout the last three years, which personal home care providers have certainly appreciated. There’s been less support for Medicare-certified home health services, however.

“The Biden-Harris Administration has distributed $37 billion from the American Rescue Plan across all 50 states for home- and community-based services,” Becerra continued. “Additionally, we are delivering new guidance to states about how direct worker registries can help ensure more individuals receiving Medicaid-covered services can receive care in a setting of their choice.”

CMS’ new guidance outlines “how states can establish important tools to connect individuals needing care with those qualified to provide it,” according to the agency.


The guidance focuses on the benefits of worker registries and the federal funding available to build out and maintain those registries from American Rescue Plan funds.

“It’s critical that people, particularly older Americans and people with disabilities, are able to receive care in the setting of their choice,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “To achieve that vision, communities need clear links to the qualified professionals best trained provide that care. Helping states build and maintain worker registries will enable more people to find and receive high-quality, affordable, and person-centered care at home and in the community.”

There’s a high demand for HCBS and direct-care workers in the U.S., which help seniors and those with disabilities age in place.

A recent report from the New York-based advocacy and research organization PHI found that more than 900,000 home care workers would be needed to meet demand by 2031. That’s not even considering those that will leave the field during that time period.

CMS’ focus on workforce registries is to ensure that those in need of care – and those qualified to provide care – can more easily find each other.

“This guidance marks another step towards supporting access to quality HCBS so older adults and individuals with disabilities can live safely and independently in their homes and communities,” the CMS release read. “These efforts include enhanced Medicaid funding for HCBS provided through the ARP; proposed rulemaking, including to improve access to care, care quality, and health outcomes, as well as better address health equity issues in the Medicaid program; and work with partners across government, including at the Department of Labor, to improve the type of data available on this workforce.”

Currently, there’s a proposed rule out there from CMS that would force HCBS providers to direct 80% of reimbursement to home care workers. 

The home-based care provider community has responded strongly to that proposed rule, asserting that a blanket wage mandate could adversely affect providers in certain areas.

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