State Medicaid Home & Community-Based Services (HCBS) Programs Respond to COVID-19: Early Findings from a 50-State Survey

Issue Brief
  1. The total number of HCBS waivers may differ somewhat for FY 2021. That data will be included in a subsequent report.

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  2. The 10 states that did not respond by mid-July 2021 are Connecticut, District of Columbia, Georgia, Hawaii, Minnesota, New Hampshire, New Mexico, North Carolina, Tennessee, and Utah.

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  3. Thirty-nine states responded to this survey question.

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  4. Illinois reported that the state agencies operating its HCBS waivers for seniors, people with physical disabilities, and people with HIV/AIDS are reporting COVID-19 cases and deaths among those enrollees to local health departments, and managed care plans are tracking COVID-19 cases and deaths across several Illinois HCBS waivers, but this information is not publicly available.

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  5. Thirty-eight states responded to this survey question.

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  6. Thirty-six states responded to this survey question.

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  7. This initiative was reported by five states (Florida, Massachusetts, New Jersey, Ohio, and Virginia).

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  8. This initiative was reported by three states (Illinois, Pennsylvania, and Wisconsin).

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  9. Thirty-nine states responded to this survey question.

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  10. Thirty-seven states responded to this survey question.

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  11. Thirty-eight states responded to this survey question.

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  12. Thirty-four states responded to this survey question.

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  13. Thirty-eight states responded to this survey question.

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  14. Thirty-nine states responded to this survey question. Our survey asked states whether they actually used CMS-approved authority to provide retainer payments. KFF’s Medicaid emergency authorities tracker lists states with CMS-approved authority, without indicating whether states actually used an approved authority. This difference may account for discrepancies in state totals between the two sources.

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  15. Since 2000, CMS Olmstead guidance has permitted states to make retainer payments to personal care and attendant service providers while an HCBS enrollee who usually receives those services is hospitalized or absent from their home. This policy places personal assistance services on equal footing with nursing facility services, for which states are allowed to make bed hold payments in an enrollee’s absence. The 2000 guidance applies to personal assistance services provided through HCBS waivers and allows a retainer payment period of 30 consecutive days or the number of days for which the state allows a nursing facility bed hold payment, whichever is less. CMS’s Section 1115 COVID-19 demonstration waiver template allowed states to request authority to make retainer payments to habilitation and personal care service providers affected by the pandemic in an effort to preserve this provider network. CMS COVID-19 guidance clarified that retainer payment authority also is available as a regular state plan amendment or a disaster state plan amendment for Section 1915 (i) HCBS and Community First Choice attendant services as well as through HCBS waiver Appendix K. CMS, COVID-19 Frequently Asked Questions (FAQs) for State Medicaid and Children’s Health Insurance Program Agencies, at pp. 101-102 (last updated Jan. 6, 2021), https://www.medicaid.gov/state-resource-center/downloads/covid-19-faqs.pdf.

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  16. Twenty-eight states responded to this survey question. One state reported that it used retainer payment authority but did not respond to this follow-up question.

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  17. Consecutive days are those that are eligible for billing, which means that 30 consecutive billing days for services provided Monday through Friday encompasses a 6-week period. CMS, COVID-19 FAQs, supra. n.16 at p. 99.

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  18. The revised policy is retroactive to January 1, 2021. CMS State Medicaid Director letter, SMD #21-003, Implementation of American Rescue Plan Act of 2021 Section 9817:  Additional Support for Medicaid Home and Community-Based Services during the COVID-19 Emergency, at p. 11 (May 13, 2021), https://www.medicaid.gov/federal-policy-guidance/downloads/smd21003.pdf.

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  19. Forty-one states responded to this survey question.

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  20. States have until March 31, 2024 to spend the enhanced funds.

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