ARPA HCBS Initiative


In March 2021, Congress enacted the American Rescue Plan Act (ARPA) in response to the ongoing Covid-19 Public Health Emergency. This law gave states additional money for home and community-based services. Specifically, Section 9817 of the Act provided states with a 10% Federal Medicaid Assistance Percentage (FMAP) enhancement on Medicaid expenditures for Home and Community-Based Services (HCBS) provided between April 1, 2021 and March 31, 2022. In return for this one-time funding boost from the federal government, states are required to spend an amount equal to the enhanced FMAP on HCBS-related services between April 1, 2021 and March 31, 2025.

The ARPA HCBS Funding Initiative represents the largest infusion of new federal resources into the nation’s HCBS system over the last 30 years, with an estimated $35 billion in total spending between 2021 and March 2025. States have a wide range of discretion for how to invest the funding, including direct services, eligibility expansions, provider payment increases, recruitment and retention activities, improving quality, and strengthening program administration and oversight.

While ARPA was a much-needed response to the public health emergency, it also created a truly unique opportunity for states to make strategic investments that both addressed the short-term urgent needs exacerbated by the Covid-19 Public Health Emergency (PHE) and assisted in state efforts to shore up those areas longer term. These investments have affirmed the need for long-term, sustainable approaches to ensure that HCBS is available to all individuals who need them. 

Due to its time-limited structure, the ARPA HCBS Funding Initiative presented a significant challenge to states. With a substantial amount of funding made available to states, the Centers for Medicare & Medicaid Services (CMS) established a relatively short timeline to expend the funds, and many state initiatives focused on expanding and reforming benefits for HCBS recipients as well as modernizing HCBS infrastructure.

These expansions in benefits and infrastructure initiatives often require extended periods of time to conduct stakeholder engagement around design issues, procure new types of vendors, and conduct detailed planning around implementation approaches. Most states did not have existing capacity to implement the new initiatives in their HCBS Spending Plans and therefore had to either hire new staff or procure outside assistance. Regardless of the approach, a substantial amount of time is required to either recruit new employees or secure contractual assistance.

A collection of foundations quickly realized that states would need immediate assistance to make the best use of these time-limited Federal funds.  Through the generous support of The John A. Hartford Foundation, The SCAN Foundation, the Care for All with Respect and Equity (CARE) Fund, the Milbank Memorial Fund, and The John A. Hartford Foundation, and Arnold Ventures, and the Peterson Center for Healthcare, the ARPA HCBS Technical Assistance Collective came together to provide a range of technical assistance and resources for states between October 2021 and March 2024. 

The ARPA HCBS Technical Assistance Collective brings together four organizations with deep expertise in HCBS systems: ADvancing States, Halperin Health Policy Solutions, the National Association of State Directors of Developmental Disability Services (NASDDDS), Riverstone Health Advisors, as well as Brian Burwell. The TA Collective’s mission is to support states as they strive to maximize the impact of the unprecedented HCBS funding available under the American Plan Rescue Act. 

Details on each of these activities are available on this page.