Ready Lists Might Be Eradicated For Incapacity Providers Supplied By Medicaid

Marisol Ramos, left, wipes excess makeup off her daughter Naomi’s cheek as the family prepares for a shopping spree in 2017. Naomi is mentally retarded and spent years on a waiting list before finally receiving government-funded services. (Michael Bryant / The Philadelphia Inquirer / TNS)

Work is underway on laws that could fundamentally change the national system of home and community-based services, eliminate waiting lists, and enable people with disabilities to move across state borders without sacrificing critical services and support.

A bill unveiled this month, known as the HCBS Access Act, would require Medicaid to provide home and community-based services to all eligible individuals, and set the minimum levels of services that states must provide. The bill is also intended to help states build a network of providers and workers to provide such support.

The plan is being promoted by U.S. Representative Debbie Dingell, D-Mich., Along with Sens. Maggie Hassan, DN.H., Bob Casey, D-Pa. And presented to Sherrod Brown, D-Ohio.

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Legislators said the “draft discussion” is a “first step in creating HCBS support for anyone eligible and choosing HCBS,” and they are seeking feedback from stakeholders in the coming weeks before starting the roll-out of a formal bill.

“The HCBS Access Act would be a major paradigm shift,” said Nicole Jorwic, senior director of public policy at The Arc, which advocates for legislation. “It is not an exaggeration to say that this would mean a change in services and support for people with disabilities.”

Since the home and community-based services emerged in the early 1980s, they are optional. The states offer the services through Medicaid exemptions, which vary greatly from place to place and are only possible to a limited extent. This means that people with disabilities often spend years on waiting lists before they can access support services. The waivers are tied to the state in which a person lives. When a person moves, they often have to restart the waiting list process. In contrast, Medicaid guarantees institutional services to those who qualify.

This would change after the draft law. Home and community-based services would be mandatory in the Medicaid program, much like institutional services already are.

“It would be life-changing for the 850,000 people on waiting lists,” said Jorwic. “When you include so many people in this system, you are not only helping people get support and services, but also family carers who are currently filling the gaps in the service system.”

The bill would send more federal funding to states and create a basic menu of required services for individuals and communities across the country that states could improve. Proponents say this would remove confusion for families and make things easier for states that are currently running a number of derogation programs, each with their own audiences and rules.

Legislators have also indicated that they intend to include provisions in the bill to strengthen the workforce that supports people with disabilities in the community. However, details of this part of the plan are currently lacking.

The move comes after President Joe Biden proposed removing waiting lists for home and community services and increasing the workforce for direct care during his campaign last year.

“The current system is an artifact of a law over the age of 55 that never provides community-based support for older adults and people with disabilities,” said a statement to stakeholders from the Hassan, Brown, Casey and Dingell offices . “The time has come to establish basic criteria for the delivery of HCBS across the country and make these basic services a Medicaid claim.”

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