By: Elizabeth Edwards, Dania Douglas, and Michelle Yiu
Expanded services and coverage under the Affordable Care Act (ACA) and its Medicaid expansion provide states opportunities to decrease waiting lists for Medicaid home and community-based services (HCBS) and generally increase access to services for people with disabilities. HCBS programs offer states a great degree of flexibility to design a Medicaid-funded program that targets a special set of Medicaid services only to a limited population, both in size and type of service needs. The ACA responded to the increasing demand for HCBS by increasing opportunities and incentives for states to expand and innovate their HCBS programs. Those HCBS opportunities provide states with more flexibility in designing programs and create broader availability of HCBS, thus putting less pressure on traditional HCBS programs with waitlists. The ACA also created Medicaid expansion, which covers many adults with disabilities, including some on HCBS waiting lists, who previously fell into coverage gaps and could not access non-HCBS Medicaid services. The ACA has had a positive impact on those needing HCBS.