Home- and community-based services (HCBS) workforce shortages affect the ability of Medicaid programs to serve people with long-term care needs in the home or community. Although some factors that affect the HCBS workforce are outside of Medicaid’s purview, many states are exploring ways to use Medicaid payment policy to expand the HCBS workforce and reduce worker turnover. In previous MACPAC public meetings (November 2023 and March 2024), we discussed findings from federal and state interviews that explored strategies to ensure that HCBS payment rates are adequate to attract and retain a sufficient workforce.
Building on these findings, we convened a technical expert panel (TEP) with federal and state officials, HCBS payment experts, actuaries, beneficiary advocates, and provider groups. The purpose of the TEP was to better understand how Medicaid payment policies can be used to bolster the HCBS workforce. This session summarizes the themes that emerged from the TEP discussion and contextualizes them within the findings from our previous work on HCBS payment. Key findings include the importance of comprehensive and aligned rate assumptions and consistent rate reviews.
