JUSTICE IN AGING: Medicaid Home and Community-Based Services for Older Adults: A Primer
This primer from Justice in Aging details Medicaid’s Home and Community-Based Services (HCBS), which enable older adults and individuals with disabilities to receive daily care, therapies, and personal assistance at home rather than in institutional nursing facilities. Although the vast majority of older adults prefer community living, accessing HCBS remains difficult due to strict state-by-state financial and functional eligibility rules, federal funding caps, and a historical "institutional bias" in Medicaid law that mandates nursing home coverage while leaving HCBS optional. These systemic barriers lead to extensive waitlists, stark regional and racial disparities, and significant financial burdens on families—challenges that threaten to intensify following legislative budget cuts under H.R. 1 and shifting legal interpretations of community integration mandates
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