Most aging adults and adults with disabilities will require assistance to remain living in their homes and communities at some point over their lifetime. However, who is able to get these services is highly dependent on factors like race, ethnicity, age, disability, language, and others.
This Equity Framework for Evaluating California’s Medi-Cal Home and Community-Based Services for Older Adults and People with Disabilities was created specifically for California’s various Medi-Cal Home and Community-Based Services (HCBS) programs, and is also a valuable tool for policy makers, providers, advocates, and interested parties in other states because it provides a framework for evaluation that is applicable to HCBS programs everywhere.
HCBS programs are susceptible to systemic racism, discrimination, and bias that ultimately lead to disparities in health outcomes and quality of life for older adults and people with disabilities. Seemingly neutral HCBS policies and program rules can actually perpetuate existing inequities or result in unanticipated inequities due to longstanding discrimination in health care and society more broadly.
Specifically, the Framework identifies five domains of HCBS programs where inequities can arise: 1) Program Design; 2) Provider Availability; 3) Program Awareness and Enrollment; 4) Assessments and Authorization of Services; 5) and Provision of HCBS. For each domain, the Framework provides examples of how inequities can arise and puts forth additional policies, program rules, and decision points in which an equity evaluation should be considered.