Many aging adults and people with disabilities will need support and assistance throughout their lifetimes. Medicaid (or Medi-Cal in California) is an important payer for these services provided in the home, called home and community-based services or HCBS. Absent Medicaid, people generally do not have access to these services unless they are able to pay out-of-pocket.
However, qualifying for Medicaid doesn’t guarantee access because the federal government doesn’t require states to pay for HCBS services, while it does require states to pay for institutional (or nursing facility) care. Further, whether or not you can receive services may depend on where you live, what race you are, or your disability, so there are built-in inequities in how the scarce services are distributed.
The first in a new series of issue briefs from Justice in Aging on building equity in long-term care aims to support state agencies, policymakers, and interested parties in efforts to equitably rebalance the provision of services from institutions to home and community-based settings. Though written with a California lens and data, Beyond Spending—Measuring California’s Progress Towards Equitable HCBS, introduces the concept of equitable rebalancing that is relevant in every state. And this series of briefs is meant to serve as a model for other states.
Though there has been a nationwide effort to rebalance the funding Medicaid provides away from institutions and toward in-home care, limited data collection, reporting, and evaluation means progress towards the goal of rebalancing remains largely unknown. And whether rebalancing has been equitable—particularly with regard to age, disability, race, ethnicity, sexual orientation, gender identity, geography, and other factors—has only recently become a focus.