Promoting Access to Medicaid Home and Community-Based Services in Health Care Reform Draft Talking Points

August 11, 2009

Promoting Access to Medicaid Home and Community-Based Services in Health Care Reform


  • It has been well-established that more Americans, when in need of assistance with long-term services and supports, would prefer to live at home and in the community when possible. In a June 2009 survey by Lake Research Partners, funded by the SCAN Foundation, an overwhelming 92% of respondents said it was important to improve insurance coverage for services that help people remain at home instead of going into a nursing home.
  • Medicaid funding is currently heavily biased toward institutional care. Only 25% of Medicaid spending on long-term services and supports for older people and adults with physical disabilities goes toward home and community-based services.
  • Improving access to Medicaid home and community-based services would enable millions of Americans to maintain their independence, dignity, and choice in the face of daunting health-related challenges. 
  • Improving access to cost effective Medicaid home and community-based services could promote cost savings.  A recent study shows that states with high investment in HCBS have shown some savings over time (Harrington et al, Health Affairs Jan/Feb 2009).  According to an analysis by SEIU  increasing the federal match for Medicaid home and community-bases services and adopting best practices related to nursing home diversion can reduce Medicaid spending over time.
  • The CLASS Act, currently included in both the Senate HELP Committee bill and the House Energy and Commerce Committee bill, would be a significant step toward ensuring that more Americans have access to home and community-based long-term services and supports.  However, the CLASS Act is primarily targeted to people currently employed and their spouses, and has a five year vesting period before enrollees can receive benefits.  Therefore, those currently on Medicaid and those in the process of spending down their income and assets will not receive coverage under the bill.
  • The Congressional Budget Office has scored the CLASS Act and found that it will save Medicaid a total of $4.4 billion over ten years -- $2.5B in Federal funding and $1.9B in State funding. These savings should be directed back into Medicaid in order to increase access to home and community-based services.
  • Important bills that improve access to Medicaid home and community-based services and/or provide for savings to Medicaid as a direct result of increasing non-Medicaid home and community-based services include: the Empowered at Home Act (S. 434 and H.R. 2688); the Community Choice Act (S. 683 and H.R. 1670); the Home and Community Balanced Incentives Act of 2009 (S. 1256); and Project 2020: Building on the Promise of Home and Community-Based Services  (S. 1257 and HR 2852).
  • Investing CLASS Act savings into Medicaid home and community-based services would not only benefit low-income seniors and people with disabilities, but could also provide much-needed assistance to states (e.g. through an increase in the federal Medicaid match) that are currently struggling with serious budget issues. The more tools states have, the more they and Federal taxpayers can benefit from improving access to generally less expensive home and community-based services.