Streamlining Medicaid Home and Community-Based Services: Key Policy Questions

Medicaid’s current home and community-based services (HCBS) programs represent a 35 year incremental approach to system design. Since the early 1980s, Congress has amended the law numerous times, seeking to ameliorate the program’s institutional bias by creating new authorities and incentives for states to offer HCBS. While substantially increasing beneficiary access to HCBS, these initiatives also have resulted in a patchwork of options, contributing to administrative complexity for states and confusion for individuals seeking services. Recently, policymakers have begun discussing how states and beneficiaries might be helped by a streamlined Medicaid state plan authority. This issue brief draws on features of the various existing Medicaid HCBS programs to identify key policy questions raised by initiatives to streamline Medicaid HCBS.