Home and Community-Based Services: Public Policies to Improve Access, Costs, and Quality

Source: Charlene Harrington, Terence Ng, Stephen H. Kaye, Robert Newcomer, Center for Personal Assistance Services, January 2009

Medicaid home and community based services (HCBS) have been the focus of widespread efforts by the federal and state government to expand access. The focus of this report is to examine issues of access, cost, and quality for Medicaid HCBS programs. The trends in state Medicaid HCBS programs, target groups, participants, and expenditures are summarized. The paper shows the progress in providing Medicaid HCBS but also identifies many current problems and policies. Inequities in access to services and limited funds result in unmet needs for HCBS. HCBS cost issues have been a primary focus of policy makers and quality problems are largely not addressed. Policy recommendations are made to improve access, costs and quality at the federal and state levels in the future.

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