The American Rescue Plan Act Created an Opportunity for States to Expand Home and Community-Based Services

The American Rescue Plan Act has created an opportunity for states to expand home and community-based services (HCBS) as a response to the COVID-19 pandemic. This funding was designed to provide a federal match for critical infrastructure to ensure that people eligible for Medicaid can safely and independently remain in their homes while still receiving needed services, such as nutritious meals, transportation, home respite, and palliative care. Funders are also supporting states by offering technical assistance through ADvancing States, which will enable select states to develop a Project Management Plan for some or all of the initiatives proposed. C-TAC members, including state coalitions, play an important role in helping state governments ensure that they have enough information about how to allocate these resources and understand where gaps can be filled for people with serious illness.

Much of the time, states lack the resources internally to accelerate necessary changes to the medical or social service system that they identify over time. During the COVID-19 pandemic, the American Rescue Plan Act was passed, including a provision to allow states to apply for an additional 10% of Federal Medical Assistance Percentage (FMAP) funding to enhance, expand, or strengthen home and community-based services (HCBS) to Medicaid beneficiaries in their states. 17 states have been conditionally approved, and 34 states have received partial approval for funding, including the District of Columbia. They have until March 31, 2024, to use these funds. The most common activities undertaken by states include:

• Strengthening the provider workforce
• Enhancing the use of technology and telehealth
• Expanding services under waivers, state plan amendments, and health programs
• Improving quality
• Impacting social determinants of health

One state that achieved partial approval for funding is Hawai’i, which intends to use its ARPA funding to expand access to palliative care services under a new benefit, including directing funding to expand their workforce capacity to deliver care, improve technology and integration of services, and to ensure that beneficiaries and the community are educated and aware of the availability of new and existing home and community-based services. ADvancing States and the Stupski Foundation are supporting Hawaii to develop a plan to use those resources, in partnership with their state palliative care task force, Hui Pohala, state palliative care coalition, Kokua Mau, and Respecting Choices.

In ADvancing states, 5 states were selected for the opportunity to receive in-depth technical assistance to advance their Project Management Plans, including Hawaii, New Jersey, North Dakota, South Carolina, and Texas. Twelve more states were selected to participate in affinity groups to support workforce development efforts and enable technology to expand access to home-and community-based services.

C-TAC, in partnership with the Petrie Flom Center at Harvard Law School, will be holding a virtual event Emerging Policy Opportunities for Community-Based Serious Illness Care on April 27, 2022, from 1:00-3:00 ET, focused on the impact states can have on expanding services for people with serious illness.