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Issue Brief & Fact Sheet: HCBS Equity Framework

Most older adults and people with disabilities want to be able to receive help with daily activities at home and in their communities. This type of help, which is called Home and Community-Based Services (HCBS), enables older adults to remain independent at home rather than being forced to move into an institution. 

Like in health care broadly, the systemic drivers of health inequities—racism, ageism, ableism, classism, sexism, xenophobia, and homophobia—are embedded in laws, policy, governance, and culture that shape HCBS programs. As a result, the Medicaid HCBS “system” is a patchwork of programs with wide variation among and within states, leading to inequities in who has access to the supports and services needed to live in the community and who has no option but to receive care in an institutional setting. 
To address these disparities and achieve health equity for older adults and people with disabilities, policymakers, advocates, and other stakeholders must begin by evaluating HCBS program policies and rules to ensure they are neither preserving nor causing inequities.

Justice in Aging developed an HCBS Equity Framework to support policymakers, payers, providers, advocates, and consumers in making equity a primary focus at every stage of HCBS program design and implementation. 

Our new issue brief, An Equity Framework for Evaluating and Improving Medicaid Home and Community-Based Services, describes how inequities can be embedded in various aspects of program design, provider availability, program awareness and enrollment, assessments and authorization of services, and provision of HCBS. It includes examples of how these inequities show up in existing HCBS programs and offers tips for stakeholders to begin to evaluate and improve programs in their state. A companion Fact Sheet can be found here.

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