Over the past several years, the Commission has focused on rebalancing long-term services and supports (LTSS), that is, shifting Medicaid spending on LTSS from institutional services to home- and community-based services (HCBS). Under the statute, states must cover institutional care, but coverage of HCBS is optional. In addition, the combination of state plan authorities and waivers used to provide HCBS has resulted in a complex system design for both beneficiaries and states.
In December 2021, MACPAC convened a roundtable of federal and state officials as well as key stakeholders to consider the design of a core benefit that would streamline access to and address the incentive for HCBS rather than institutional care, and to think through design elements. This presentation focused on tradeoffs and considerations for designing a core HCBS benefit. It included takeaways from the roundtable, core HCBS benefit design considerations, as well as key issues for Commission discussion.