If you like to gamble and know a thing or two about post-acute care, it seems pretty clear where to put your money at this point: home- and community-based services (HCBS).

Two developments in recent days helped make that case. One is a new report from the Kaiser Family Foundation, which found that the realignment of long-term services and supports (LTSS) toward HCBS keeps moving in that direction. In fiscal year 2019, the most recent year in which data are available, HCB LTSS made up 59% of total spending — the highest to date — while institutional LTSS comprised 41% of total spending. The gulf has continued to widen since fiscal year 2013, when HCBS surpassed institutional care in the share of LTSS dollars.

Another, perhaps even more significant indication came from a key source: Jennifer Bowdoin, Ph.D., director of the Division of Community Services Transformation for the Centers for Medicare & Medicaid Services. During a session this week of the legislative and regulatory conference of the National Association for Long Term Services and Supports, she pointed out that there is strong legislative and regulatory momentum toward home- and community-based services. The reasons by now are clear. It is where people want to receive services and it has proven to be less costly than institutional care.

As an example, states are using the funds designated from Section 9817 of the American Rescue Plan to bolster their HCBS. It is estimated they are spending $25 billion on HCBS from the investment. For those that need more of an incentive to grow HCBS, there is a ripe carrot dangling in the form of the Money Follows the Person demonstration program, which offers a higher reimbursement rate and more flexibility to provide additional HCBS services, she pointed out.  

All of this is probably not new to home care providers, who have to be in-the-know on state funding and rules regarding services. But it’s nice to see that when it comes to healthcare policy and payments, there’s no place like home.

 Liza Berger is editor of McKnight’s Home Care. Email her at [email protected].