Keep Essential Care: Home and Community-Based Care

Keep Essential Care: Home and Community-Based Care

COVID19 is having an unprecedented impact on the lives of billions of people. But a robust and effective COVID19 response must not be a vehicle for denying access to essential health care services.

NHeLP is fighting to protect access to the range of critical services that people — especially low-income and historically vulnerable communities — need in order to live their lives. Yes, even in a pandemic. Especially in a pandemic.

On a regular day, Medicaid home and community-based services (HCBS) play a crucial role in keeping people with disabilities safely at home and in their communities. During the COVID-19 pandemic, these services are both more important, and under more stress, than ever. Medicaid HCBS — a general term that encompasses 1915(c) waiver services, state plan personal care and home health services, and other state plan services — provides support and services to over 4.3 million individuals. Many HCBS participants are in the high risk COVID-19 group because of age or underlying medical conditions. During the COVID-19 pandemic, helping people stay at home and out of hospitals, institutions, and other congregate settings is particularly critical — not only to those individuals’ lives and their civil rights, but also to the welfare of others who may need care at those same institutions. 

HCBS programs are typically designed to both help people stay in their homes and participate in the community. Under the recommended social distancing and stay put orders, a person’s services may change, such as switching out congregate day programs like Adult Day Health, for more home-based services. These changes may also require an increase in individual budget amounts or exceeding previously set limits on services. All of which are allowed, and some states are doing, under the HCBS authorities that cover the most HCBS participants. 

However, the needed HCBS and, critically, the providers for those services may not be available. HCBS provider availability is already an issue in many areas, and the pandemic will exacerbate this problem. The direct care workforce is under immense pressure. The  impacts of COVID-19 may cause many direct care workers to not work because of their own caregiving requirements at home, such as children out of school or sick family members, their own health, or other job responsibilities. Nine out of ten direct care workers are women, they are more likely than the average worker to be single parents, and most workers have two or three jobs.  At the same time, direct care workers are at risk of losing their jobs, and participants are at risk of losing providers, if a participant is quarantined or hospitalized due to COVID-19.  Without appropriate supports,HCBS could become incredibly difficult, if not impossible to access for HCBS participants. 

States with HCBS programs through 1915(c) waivers can submit an Appendix K to increase flexibiltites in their waivers and pursue changes to other programs through state plan amendments, 1135 waivers, and other mechanisms. Some services do not require states to submit changes, such as home health services, which already may be provided telephonically. However, the move to telephonic services could be difficult for HCBS participants who rely on limited minute, government-funded phones–an issue advocates have pushed to change in this emergency.  

With the authority they have to make changes, states can offer increased rates to providers and change provider qualifications. They can also offer additional services that allow people with disabilities greater control over their services and allow them to receive services, like home delivered meals, through non-traditional mechanisms. States must take significant steps to be creative with their HCBS programs to ensure access to providers and flexibility in services for HCBS participants. 

And given the flexibility the HCBS programs must quickly adapt to meet the needs of HCBS participants and keep them safely at home instead of forcing them to go to institutions to access necessary care.

Published Blogs in this Series:

Introductory Blog


Home and Community-Based Care

Direct Service Professionals

Maternal Health

Mental Health Services


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