As the COVID-19 public health emergency goes away, so will flexibilities that states put in place to expand access and investment in home- and community-based service programs.
Many state relief policies created by 1115 waivers or Appendix K changes to 1915(c) waivers received an expiration date of six months after May 11, the last day of the PHE. Though the Centers for Medicare & Medicaid Services recently granted an extension for certain HCBS waivers, many programs could still see decreased utilization and higher costs as supports begin to wind down, a report by KFF found.
Policies that allowed for virtual eligibility evaluations in 23 states will sunset on Nov. 11. Also, increased utilization limits for HCBS programs will expire in 21 states, and 19 will reinstate prior authorization requirements for these services at the same deadline. Nine states boosted payment rates for HCBS providers amid the COVID-19 pandemic, but these will also come to an end in November, constricting these providers’ cash flow and support.
Patients, providers and caregivers especially will likely feel the effects, the report noted. Many state policies allowed family caregivers to be paid for their work giving aid to loved ones with disabilities. In a dozen states, policies that allowed family caregivers to receive designation as paid providers will expire. Lower reimbursement for HCBS providers could also exacerbate challenges brought about by workforce shortages, the report noted.
Ongoing Medicaid unwinding has also strained patients’ access to HCBS following the end of the PHE. Procedural changes and altered eligibility requirements have led 6.5 million Medicaid beneficiaries to lose coverage as of September, the report said.
Still, the COVID-19 PHE brought about some permanent, lasting changes. Almost all states now offer some supports for family caregivers, such as respite care, caregiver training or other types of counseling. Some caregivers are still able to be paid for their services; in 45 states, a waiver will allow aides of people over 65 years old, or those with physical disabilities, to be paid by their state, according to the report. More than half of states will maintain higher levels of funding for HCBS, even after the end of the PHE.
