The Politics of Autism includes an extensive discussion of insurance and Medicaid services for people with intellectual and developmental disabilities. Home and Community-Based Services (HCBS) are particularly important.
Biden will allocate $450 billion to give more people the choice to receive care at home or in supportive community situations, or to have that choice for their loved ones. He will help states offer cost-effective options for affordable primary and preventive care, and affordable support services like help with meals, transportation, home safety, and quality day programs for older Americans. This commitment will reduce health expenditures, help more Americans avoid unnecessary and expensive hospitalizations, and result in an expansion of the caregiving and community health workforce by roughly 1.5 million jobs. Specifically, Biden will:
- Eliminate the current waitlist for home and community services under Medicaid. Approximately 800,000 people are on the waitlist for home and community care under Medicaid. It can take as many as five years for these individuals to get the services they badly need. Biden will increase Medicaid funding to states, the District of Columbia, and outlying territories to pay for the full cost of ensuring these 800,000 individuals and families receive long-term services and supports in the most appropriate setting, with the support of qualified care providers. Following the elimination of the current waiting list, states will be given a choice to convert their current home and community based care services waivers into a new state plan option with an enhanced federal match. This will enable states to make home and community-based services more available to people in need.
- Establish a long-term services and supports innovation fund to help expand home and community-based alternatives to institutional care. Biden believes we must move aggressively to eliminate the institutional bias that pervades our public programs. A Biden Administration will dedicate substantial resources to this fund to help states and locally based entities test innovative models that expand home- and community-based alternatives to institutional care. These could include approaches that provide care while allowing individuals to retain independence, such as day programs and respite services that enable unpaid caregivers to work, alternative home and community models that coordinate or directly provide care, and Medicaid buy-in models. For example, the CAPABLE (Community Aging in Place-Advancing Better Living for Elders) Program provides home repairs and modifications to help create safer, more functional home environments for older adults. An initial trial in Baltimore found about $3,000 in program costs yielded more than $20,000 in savings. The pilot is now being tested in 27 cities in 16 states. Successful, cost-effective approaches to long-term care will be scaled up nationally. This fund will be administered by the Center for Medicare and Medicaid Innovation, which was established by the Affordable Care Act to support innovations that improve health care while constraining costs