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Medicaid Payment Policies to Support the Home- and Community-Based Services Workforce

This session reviewed 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. Staff presented initial findings from a review of state payment policies and interviews with national experts. The presentation identified five policy issues for further examination in future work:

  1. The data used to develop fee-for-service (FFS) rate setting;
  2. Budget constraints that affect a state’s ability to finance HCBS rates at levels recommended during the rate-setting process;
  3. The use of self-directed services and managed care to pay rates that may differ from FFS;
  4. Policies to regulate the share of HCBS payments agencies spend on HCBS worker wages; and
  5. Non-financial policies to increase HCBS worker recruitment and retention.