States Adjust Home and Community Based Services Due to COVID-19 Pandemic

According to the Kaiser Family Foundation, approximately 4.3 million Americans receive Home and Community Based Services (HCBS). HCBS typically are provided to the elderly or people with disabilities. They include functional assistance with everyday activities, such as getting dressed, cooking, and bathing. Notably, over 2.5 million HCBS recipients obtain necessary services through a Section 19 (c) waiver, which allows states to provide HCBS though Medicaid funding. All 50 states and Washington D.C. provide HCBS services through such Section 19 (c) waivers.

Unfortunately, the COVID-19 pandemic has made providing HCBS far more difficult. After all, the elderly and individuals with disabilities face an increased risk of having adverse health effects due to COVID-19. Because HCBS involve providers working on a daily basis in extremely close proximity to multiple people who are elderly or have disabilities, HCBS increase the likelihood that the coronavirus will spread among particularly vulnerable HCBS recipients and healthcare providers alike.

In response to the COVID-19 pandemic, states have sought to adjust HCBS to make them safer. Specifically, the federal Center for Medicare and Medicaid Services (CMS) has approved 182 Section 1915 (c) Appendix K waivers. Appendix K waivers allow states to temporarily change HCBS programs during a state of emergency. As of February 2021, all 50 states have applied for at least one Appendix K waiver adjustment. States have sought to support both HCBS recipients, who need additional provisions to maintain their safety during the COVID-19 pandemic, and HCBS providers, many of whom require financial assistance due to COVID-related economic restrictions.

Most states have received certain COVID-related Appendix K waivers supporting HCBS recipients, such as eliminating in-person hearing requirements, extending reassessment due dates, expanding service settings, and adding electronic methods of HCBS delivery. Other examples of such Appendix K waivers include:

  • California and Indiana prioritizing waiver services for individuals who are COVID-19 positive;
  • Rhode Island and Utah reducing post-eligibility income contribution requirements for HCBS service recipients; and
  • Maryland and Utah increasing the number of potential HCBS recipients.

Most states also have received Appendix K waivers supporting HCBS providers during the COVID-19 pandemic, such as modifying HCBS provider qualifications, directly paying HCBS providers, and increasing HCBS service payment rates to match COVID-related costs. Other examples of such Appendix K waivers include:

  • Missouri limiting the number of HCBS service recipients to best distribute HCBS providers’ resources;
  • California extending emergency paid sick leave for HCBS service workers who cannot work due to COVID-19; and
  • Kentucky tracking COVID-19 cases among waiver enrollees.

As the COVID-19 pandemic continues, state governments have had to alter the provision and regulation of countless healthcare services. HCBS are no exception. Through Appendix K waivers, states have enacted innovative policies to ensure at-risk elderly and disability populations continue to receive HCBS throughout the COVID-19 pandemic. In doing so, states continue to protect their most vulnerable populations during the COVID