This session reviewed how Medicaid payment policies for home- and community-based services (HCBS) are used to support HCBS workers, including direct care workers, direct support professionals, and independent providers. Staff presented initial findings from a review of state payment policies and interviews with national experts. The presentation identified five policy issues for further examination in future work:
- The data used to develop fee-for-service (FFS) rate setting;
- Budget constraints that affect a state’s ability to finance HCBS rates at levels recommended during the rate-setting process;
- The use of self-directed services and managed care to pay rates that may differ from FFS;
- Policies to regulate the share of HCBS payments agencies spend on HCBS worker wages; and
- Non-financial policies to increase HCBS worker recruitment and retention.
