How State Support for Medicaid HCBS Impacts COVID-19 Vaccination

States have an opportunity to use the increased federal matching for Medicaid home and community-based services (HCBS) to accelerate coronavirus vaccination uptake, a Kaiser Family Foundation (KFF) issue brief found.

In the 2021 survey, the states that responded represented 87 percent of the total healthcare spending on HCBS.

HCBS providers connect Medicaid beneficiaries and vaccination appointments and education. This group of providers have a unique opportunity to collect data about one of the more vulnerable populations of Americans. In fact, the American Rescue Plan boosted the federal matching rate for HCBS providers due to their important role in serving high-risk communities.

Medicaid HCBS providers protect patients in a variety of ways, with increasing awareness being a key strategy to combatting the spread of coronavirus in these populations. For example, over one in three respondents stated that they shared coronavirus cases and deaths data with beneficiaries.

Despite the key role that HCBS providers play in coronavirus prevention and vaccination efforts, the survey found that many states are not specifically tracking coronavirus vaccination progress through HCBS providers. Of the 41 state respondents, slightly less than half reported that they tracked coronavirus vaccination in their Medicaid HCBS populations.

One major barrier is a lack of Medicaid HCBS providers, the KFF researchers pointed out. Many Medicaid HCBS providers closed as a result of the pandemic. Two-thirds of the respondents said that at least one Medicaid HCBS provider in their state had to close down during the pandemic. 

Workforce shortages and social distancing requirements drove the closures. While the closures affected many different types of Medicaid HCBS providers, home healthcare and group homes were most impacted by workforce shortages, while adult day health and employment support programs were most impacted by social distancing.

States tried to offer financial support to HCBS providers, in light of the shutdown’s challenges. Approximately three-quarters of the respondents stated that they used retainer payments with CMS approval to channel some income toward HCBS providers. 

However, most states found that the federal limit of three 30-day episodes for retainer payments was not satisfactory for HCBS providers.

“Medicaid providers also faced challenges accessing federal provider relief funds, both in the amount of funding received and delays in allocations compared to other provider types,” the researchers noted.

States have to decide how best to use the American Rescue Plan’s increased federal matching rate for HCBS providers. Most states that shared their intentions with the KFF researchers expressed plans to put the funds towards increasing provider payment rates or workforce recruitment. 

Eighteen states planned to increase payment rates and 13 states would expand workforce recruitment efforts. Expanding the healthcare workforce will be a crucial goal in 2021, not only for the HCBS provider workforce but also for behavioral healthcare, rural healthcare, and other understaffed specialties and demographics.

Three other ways in which states might use the funds included expanding their HCBS waiver enrollment, worker training, and supporting caregivers.

However, these responses only reflect a little more than half of the states that participated in the survey overall. 

While increasing access to coronavirus vaccinations was not one of the states’ top five initiatives related to American Rescue Plan funding, CMS has clearly stated that states can use the funds to that end. States still have time to include this in their finalized initiatives for the American Rescue Plan funding.

States could build on the role of the HCBS provider to enable more coronavirus vaccinations in the Medicaid population. The researchers emphasized that having better data will be key to such a strategy and that states must address workforce shortages and other barriers in order for this approach to be effective.

“Maintaining and increasing the HCBS provider infrastructure is key to meeting enrollee need and expanding access to these services as pandemic recovery efforts continue and beyond,” the researchers concluded.