Financing HCBS

On Wednesday, March 15, 2023, MACPAC released it's March 2023 Report to Congress on Medicaid and CHIP. The report recommends a series of measures aimed at improving the collection of race and ethnicity data, increasing transparency in nursing facility payment data, and giving states greater flexibility in following Medicare drug coverage decisions. It also includers MACPAC's annual, statutorily required report examining payment policy for safety net hospitals.

On March 1, 2023 KFF released a brief titled “FAQs on Health Spending, the Federal Budget, and Budget Enforcement Tools”. The brief reviews basic questions about health spending and the federal budget and budget enforcement tools, including the debt limit and sequestration. As discussions on the federal deficit and debt continue, the KFF resource provides an explanation of federal spending for domestic and global health programs and services.

On Tuesday, February 28th, CMS released the latest enrollment figures for Medicare, Medicaid, and CHIP. As of November 2022, over 65.3 million people are enrolled in Medicare; more than 35.1 million are enrolled in fee-for-service Medicare and over 30.2 have a Medicare Advantage plan. Over 91.7 million enrollees have Medicaid and CHIP; more than 84.8 million individuals have Medicaid and over 6.9 million have coverage through CHIP. Over 12 million individuals are dually eligible for Medicare and Medicaid and are counted in the enrollment figures for both programs.

Yesterday the Centers for Medicare & Medicaid Services (CMS) announced next steps describing how the agency will implement the new Medicare Prescription Drug Inflation Rebate Program, including a timeline of key dates. As part of the Inflation Reduction Act (IRA) of 2022 (P.L. 117-169), the Medicare Prescription Drug Inflation Rebate Program requires drug companies to pay a rebate to Medicare if they raise prices for certain drugs faster than the rate of inflation. Based on a 12 month period starting October 1, 2022, drug companies will be required to pay rebates to Medicare for raising prices that outpace inflation on certain Part D drugs.

The U.S. Department of Health and Human Services, through CMS, awarded approximately $25 million in planning grants to five new states and territories to expand access to home and community-based services through Medicaid’s Money Follows the Person (MFP) demonstration program. With these awards, 41 states and territories across the country will now participate in MFP. Awards of up to $5 million have been granted to Illinois, Kansas, and New Hampshire, as well as for American Samoa and Puerto Rico. This is the first time MFP grants have been made available to territories. These awards will support the early planning phase for their MFP programs.

CMS has announced it will offer more than $110 million to expand access to home and community-based services (HCBS) through Medicaid’s Money Follows the Person (MFP) program. The new Notice of Funding Opportunity (NOFO) makes individual awards of up to $5 million available for more than 20 states and territories not currently participating in MFP. These funds will support initial planning and implementation to get the state/territory programs off the ground, which would ensure more people with Medicaid can receive high-quality, cost-effective, person-centered services in a setting they choose.

This brief shares data on state policy choices about Medicaid HCBS, including target populations, functional eligibility criteria, financial eligibility criteria, waiver waiting lists, benefit packages, out-of-pocket costs, use of capitated managed care, self-direction opportunities, covered provider types, electronic visit verification systems, and provider reimbursement rates.

The brief from the KKF shares state-level data on HCBS spending and the number of people receiving Medicaid in FY 2020. The data were collected in KFF’s 19th survey of state officials administering Medicaid HCBS programs in all 50 states and DC.

This NRP article discusses the delay many states are experiencing in regard to accessing funding from the American Rescue Plan Act, signed into law in March 2021. The increased funding could be used by states to boost wages, move people off waiting lists for disability services, train more workers, and expand covered services for older adults and people with disabilities, however the Centers for Medicare and Medicaid Services must provide approval before states can fully access their funds.

The Wisconsin Department of Health Services proposes to reinvest ARPA Home and Community Based Services (HCBS) enhanced funding to implement a statewide grant program with HCBS providers, advocates and stakeholders. These grants will address the workforce crisis, support businesses and programs transition to a model that supports individual with intellectual, developmental, and other significant disabilities find and retain work in competitive integrated employment and other innovative solutions.