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Findings from Interviews about Medicaid Payment Policies to Support the Home- and Community-Based Services Workforce

This session reviewed findings from interviews focused on how Medicaid payment policies for home- and community-based services (HCBS) are used to support HCBS workers, including direct care workers, direct support professionals, and independent providers. Building off of findings from initial interviews with national experts that were discussed at MACPAC’s November 2023 public meeting, this presentation included additional findings from subsequent interviews with state officials and stakeholders in five states.

These interviews identified multiple strategies that states are pursuing to improve HCBS rate setting to ensure that rates are adequate to attract and retain enough HCBS workers to meet beneficiary care needs. Promising practices identified include:

  • conducting data-driven HCBS rate studies that account for current needs instead of budget-based rate studies allocating a fixed pot of funding;
  • aligning payment rate assumptions across populations, services, and delivery systems; and
  • regularly updating rates to account for a changing HCS policy environment.

The presentation also addressed challenges that states face in funding HCBS rates at recommended levels and ensuring that rate increases result in increased HCBS worker wages. The presentation concluded with a discussion of non-financial strategies that states are implementing alongside payment rate changes.