Home/Community Services

In Focus Groups, Direct Care Workers and Unpaid Caregivers Describe Low-Wage, Physically-Challenging Work That is Often Mentally Overwhelming and Marked By Uncertainty

In recent focus group interviews, 32 paid direct care workers and unpaid caregivers who assist seniors and people with disabilities with self-care and household activities describe daily work defined by low pay, physical demands and mental stress that has been made worse by the pandemic. KFF conducted the four focus groups in July and August…More

Voices of Paid and Family Caregivers for Medicaid Enrollees Receiving HCBS

To help inform the ongoing debate, KFF conducted four focus groups in July and August 2021 with direct care workers and unpaid caregivers who provide HCBS, assisting seniors and people with disabilities with daily self-care and household activities. These focus groups are not necessarily generalizable to all caregivers, but can provide insight into their experiences …

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Analysis Examines Insurance Coverage, Affordability and Access to Home and Community-Based Services for Children with Special Health Care Needs

A new KFF analysis examines key characteristics of children with special health care needs, the affordability and adequacy of their health coverage, and the implications for such children of potential new federal Medicaid money to assist families in caring for them. Medicaid is a significant source of coverage for medical, behavioral health, and long-term services…More

Children with Special Health Care Needs: Coverage, Affordability, and HCBS Access

This issue brief provides context for ongoing policy discussions by describing key characteristics of children with special health care needs, comparing insurance affordability and access to key benefits among those covered by Medicaid/CHIP and those with private insurance, and considering the implications of additional Medicaid HCBS funding for children with special health care needs.

Housing Affordability, Adequacy, and Access to the Internet in Homes of Medicaid Enrollees

The COVID-19 pandemic and the ensuing economic disruption have drawn more attention to longstanding issues related to housing and internet access and how these issues can impact health. As the primary source of health insurance for low-income populations, Medicaid covers a considerable share of people living in homes that are unaffordable, inadequate, or have limited …

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Direct Care Workforce Shortages Have Worsened in Many States During the Pandemic, Hampering Providers of Home and Community-Based Services

During the pandemic many states have experienced worsening direct care workforce shortages that have affected providers of home- and community-based long-term care services (HCBS), according to early findings of a new KFF survey of Medicaid HCBS programs in all 50 states and the District of Columbia. Most states reported workforce shortages as the pandemic’s primary…More

State Medicaid Home & Community-Based Services (HCBS) Programs Respond to COVID-19: Early Findings from a 50-State Survey

This issue brief presents early findings from the most recent KFF survey of Medicaid HCBS programs in all 50 states and the District of Columbia. It focuses on state policies adopted in response to challenges posed by the pandemic, the pandemic’s impact on Medicaid HCBS enrollees and providers, and states’ initial plans for the new …

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State Options to Expand Medicaid HCBS: Examples & Evaluations of Section 1115 Waivers

States are currently developing plans to access an increased federal matching rate (“FMAP”) for Medicaid HCBS spending established in the American Rescue Plan Act (ARPA) of 2021. In the future, states may also be able to access increased HCBS funds proposed in the Biden Administration’s American Jobs Plan and the Better Care Better Jobs Act …

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State Actions to Sustain Medicaid Long-Term Services and Supports During COVID-19

As the COVID-19 pandemic continues, states have taken a number of Medicaid policy actions to address the impact on seniors and people with disabilities, many of whom rely on long-term services and supports (LTSS) to meet daily needs and are at increased risk of adverse health outcomes if infected with coronavirus.