Retaining Medicaid COVID-19 Changes to Support Community Living

Executive Summary

This article was originally published in the “Saint Louis University Journal of Health Law & Policy.”

The impact of COVID-19 on people with disabilities in institutional settings, like nursing facilities, has garnered significant attention. But people receiving comparable services in the community have also been affected significantly. States used several emergency authorities in efforts to facilitate access to and stabilize these Medicaid home and community-based services (HCBS), including behavioral health services.

Although states made different policy choices within those authorities, many states expanded the provider pool, increased HCBS provider rates, decreased onerous utilization controls and other barriers to care, expanded telehealth, and added new community-based services. These state policy responses have resulted in new services or HCBS delivery models that rely less on congregate services and reinforce the aims of Olmstead and the ADA. Converting some of the more effective emergency measures into permanent policy changes could improve health equity and help diminish longstanding legal and administrative barriers that hinder access to Medicaid-funded community-based services.

While each Medicaid agency should evaluate which of these emergency policies will be beneficial for people with disabilities in their specific state, this Article identifies several strategies that present low risks to participants, improve workforce stability, and reduce health disparities. This Article encourages states to consider integrating such policies into their HCBS programs beyond the public health emergency to strengthen the HCBS service system and improve access to these critical services.

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