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State Efforts to Address Medicaid Home-and Community-Based Services Workforce Shortages

Medicaid is the primary payer for home- and community-based services (HCBS). There is a national shortage of workers who provide HCBS to Medicaid beneficiaries, which limits the ability of state Medicaid agencies to provide adequate services to beneficiaries in the community. Low wages, high rates of turnover, and lack of advancement opportunities all contribute to this shortage.

This issue brief looks at state Medicaid levers to address the HCBS workforce shortage, and is based on a literature review, stakeholder interviews, and a panel at MACPAC’s October 2021 public meeting. State strategies for increasing HCBS workforce capacity include raising worker wages, providing benefits, expanding training opportunities, developing recruitment and retention initiatives, and supporting family caregivers. This issue brief also provides examples of state actions in each of these areas and explores how states plan to use funds provided under the American Rescue Plan Act (ARPA, P.L. 117-2) to further support the HCBS workforce.