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.
Reports & Publications
Researchers at the University of California worked with a stakeholder advisory group during a 6-month planning period to design an evaluation of Cal MediConnect, California‘s dual financial alignment demonstration. It was decided that the evaluation should begin by incorporating the experiences and voices of beneficiaries who had transitioned to Cal MediConnect or opted out.
In this report, survey questions relevant to the National Quality Forum (NQF) domains of home and community-based services (HCBS) quality are listed and classified according to the NQF domains and the question topics within domains. The report will be revised once the NQF HCBS quality domains are finalized, which is expected to occur by September 2016. Included items are limited to surveys of consumers, family members, and caregivers.
This study examined service use and expenditures for people with intellectual and developmental disabilities (IDD) living at home and in the community in California in 2005 and 2013. The number of people assessed for IDD services increased, along with the percentage of individuals who did not receive any services between 2005 and 2013. Controlling for client needs, children age 3-21 were less likely than other age groups to receive any services using logistic regressions. All racial and ethnic minority groups were less likely to receive any services than were white populations.
Although state use of Medicaid home- and community-based services (HCBS) to provide long-term services and supports to older adults and individuals with physical disabilities continues to increase, progress is uneven across states. We used generalized linear models to examine state factors associated with increased allocation of Medicaid dollars to HCBS for the period 2000 to 2011. We observed enhanced growth in states that began the period with limited investment in HCBS, as reflected in significant year trends among these states.