Updated: The Better Care Reconciliation Act Threatens the Continued Growth of Home and Community-Based Services

A line graph titled, "Figure 1. Average annual HCBS spending per non-I/DD enrollee, 2001–13, actual and reduced as if BCRA caps had been in place." A blue line shows the average national per-enrollee HCBS spending for programs targeted to people without I/DD. Beginning in 2005, a green and a red line diverge from the blue line, showing the impact that per capita caps might have had. By 2013, the green line is 23% lower and the red line 30% lower than the blue line.

The Better Care Reconciliation Act (BCRA) proposes to cap Federal Medicaid reimbursements to the states, effectively limiting growth to a rate at first only modestly exceeding the rate of inflation in healthcare costs and then falling below inflation. A new CLPC report uses state-by-state HCBS expenditures from 2001 through 2013 and compares the growth in spending during those years to the limitations that would have been in place had BCRA-like caps been imposed during those years. Findings indicate that caps would likely have caused the vast majority of states to limit HCBS growth, reducing increases in per-enrollee spending to substantially below the increases that actually occurred.  By 2013, HCBS spending for people with physical disabilities, seniors, and other non-developmental disabilities would probably have been reduced by between 23% and 30% below actual spending.  For programs targeted to people with intellectual or developmental disabilities, reductions of up to 16% would have occurred.

Download the report here.

Last modified Jul 3, 2017