Reports & Publications

July 2017
The Potential Impact of the Better Care Reconciliation Act on Home and Community-Based Services Spending
H. Stephen Kaye
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 on a per-enrollee basis, effectively limiting growth to a rate at first only modestly exceeding the rate of inflation in healthcare costs and then falling below inflation. If the BCRA were to be enacted, it is reasonable to assume that most states would limit home and community-based services (HCBS) spending to the per-enrollee cap amount; otherwise, any excess comes entirely out of the state budget.

June 2017
The Potential Impact of the American Health Care Act on Home and Community-Based Services Spending
H. Stephen Kaye
A line graph showing the divergence between actual average HCBS spending in 2001-13 with the amounts calculated if AHCA-like caps had been in place.

AN UPDATED VERSION OF THIS REPORT, BASED ON THE SENATE'S DRAFT BETTER CARE RECONCILIATION ACT, IS NOW AVAILABLE.

June 2017
Aging With a Physical Disability in Medicaid Managed Care
Tamar Heller, Randall Owen, Anne Bowers, and Hailee M. Gibbons
The cover of the journal Research on Aging

Abstract: This study examines health services appraisal (HSA) and unmet health-care needs for adults (age 50 and over) with physical disabilities in Medicaid managed care (MMC) versus Medicaid fee for service (FFS). Surveys from 309 individuals in MMC and 349 in FFS 2 years after MMC implementation included demographics, MMC processes, HSA, and unmet health-care needs.

May 2017
The Impact of Cal MediConnect on Transitions from Institutional to Community-Based Settings
Carrie Graham, Mel Neri, and Edward Bozwell Bueno
The logo of Cal MediConnect

As part of the University of California’s three-year evaluation of the Cal MediConnect (CMC) program, this research brief examines the efforts of CMC health plans to identify and transition members from long-term care institutions to home and community-based settings. Findings describe the progress many CMC plans have made in accelerating transitions out of institutional care, including successful strategies and challenges encountered in the process, as well as the barriers that still remain.

October 2016
Medicaid Home and Community-Based Services Programs: 2013 Data Update
Terrence Ng, Charlene Harrington, MaryBeth Musumeci, and Petry Ubri
Figure showing growth in Medicaid HCBS participants, by program, 2003-2013

This report summarizes the key national trends to emerge from the latest (2013) participant and expenditure data for the three main Medicaid HCBS programs: (1) the mandatory home health services state plan benefit, (2) the optional personal care services state plan benefit, and (3) optional § 1915 (c) HCBS waivers. It also briefly discusses the provision of Medicaid HCBS through § 1115 demonstration waivers and highlights findings from a 2015 survey of Medicaid HCBS participant eligibility, enrollment, and provider reimbursement policies, including those related to the U.S.

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