BIPARTISAN POLICY CENTER: A Look at Medicaid Home and Community-Based Services: Background and Policy Landscape
Medicaid Home and Community-Based Services provide essential medical and nonmedical support—such as personal care, transportation, and respite—to help older adults and individuals with disabilities live independently rather than in institutional settings. As Medicaid’s primary long-term care offering, these services have gradually eclipsed facility care in popularity while offering critical support to millions of family caregivers. However, because states deliver these benefits through optional authorities, programs remain vulnerable to state budget cuts, administrative complexity, workforce shortages, and lengthy waitlists. Recent federal legislative spending reductions have further strained state budgets, prompting local governments to restrict service hours, cut provider reimbursement rates, or implement spending caps, even as policymakers attempt to balance fraud oversight with preserving essential care access.
