What are HCBS's?
You may have heard the term “HCBS.” It is the acronym for “Home and Community-Based Services”—a Medicaid waiver program that provides assistance to Medicaid beneficiaries to receive services in their own home or community. These services often include support with functional limitations like dressing and bathing, as well as transportation, visits from healthcare providers, and case management. The need for this type of care is expected to skyrocket as America’s aging population expands to 74 million in 2030.
Current policy and budgeting efforts are underway to bolster the HCBS programs across the country to better support the “care infrastructure" provided by the 53 million Americans that care for vulnerable seniors and people with disabilities. The timing is key, considering the long waitlists for waivers in most states.
In his American Jobs Plan, President Biden has proposed increasing federal support for home-based long-term care by a staggering $400 billion over eight years. A $50 billion annual increase would represent a roughly 40 percent increase in the $129 billion Medicaid spent on longterm care in 2018 and a 70 percent increase in that year’s home and community-based services (HCBS) budget. This move reflects a widely held belief that aging Americans should have the choice to stay in their own homes and that this is a more cost-effective option than nursing home care.
One of the key components of the plan is to increase pay and benefits to the more than 790,000 caregivers providing HCBS support. The majority of these are women, immigrants, and people of color who are paid on average $12 an hour and 1/3 of whom receive no employer-backed health insurance. Without these improvements to wages and benefits, it will be increasingly difficult to recruit quality caregivers as demand grows.
William A. Dombi, President of the National Association for Home Care & Hospice, praises these efforts as a “monumental advance” in the “effort to provide full access to health care outside of an institution.”
Of course there are limitation to the reach of HCBS programs. Medicaid’s strict eligibility requirements limit services to individuals who can exhibit that they personally have no more than $2,000 in total assets, hindering the program’s ability to help lower-to-upper middle class individuals and families.
Working with an Elder Law Attorney who understands the Medicaid application process and who tracks the cost of nursing home care can be helpful as families plan for the future. An effective legal advisor can counsel clients on how they might achieve their goals, whether those are maintaining independence and dignity, preserving funds for children and grandchildren, or staying home rather than moving to assisted living or a nursing home.
The team at Hillsborough Wills & Trusts has the expertise to help you Build Your Circle of Security.