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Streamlining and Simplifying Medicaid HCBS Part I

The Bipartisan Policy Center (BPC) is continuing its efforts to improve access to longterm services and supports (LTSS). In previous reports, BPC highlighted the growing challenges associated with improving access to and financing of LTSS.1 Building on our previous work around LTSS and Medicaid home and community-based services (HCBS), BPC’s work will focus on three key policy areas:

  1. Expanding Medicaid HCBS – Report released in June 2021
  2. Improving the Availability of Long-Term Services & Supports (includes Medicaid HCBS Expansion) – September 2021
  3. Streamlining and Simplifying Medicaid HCBS – October 2021

In this report, part I of a two-part series, BPC: 1) outlines policy options to streamline and simplify the current system of HCBS waivers and state plan options; and 2) solicits feedback from stakeholders to help inform part II, which will be released in September. Part II will include final recommendations to policymakers on streamlining and simplifying Medicaid HCBS.

This report includes a brief overview of existing HCBS waivers and state plan options, followed by draft policy options. The report also includes a set of questions to help guide BPC in the development of final recommendations.

To provide feedback, please send comments to: [email protected]

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Policy Options

  1. Congress should streamline and simplify existing HCBS waiver and state plan amendment (SPA) authorities into a single, consolidated state plan amendment that retains much of the flexibility of the existing HCBS waiver authorities and state plan options. Congress should phase out existing HCBS waivers and SPAs, and require states to deliver HCBS through the new SPA within five years of enactment.
  2. Congress should provide additional resources to the Centers for Medicare & Medicaid Services (CMS) to provide comprehensive technical assistance to states on transitioning to the new consolidated HCBS state plan authority.
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