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 impact on HCBS provided in an enrollee’s home and in group homes. The pandemic has brought new attention among policymakers to the longstanding unmet need for HCBS for seniors and people with disabilities, as well as the direct care workforce shortage that has been driven by low wages, high turnover, and limited opportunities for career advancement.

The survey also finds that the HCBS provider infrastructure declined during the pandemic, with two-thirds of responding states reporting a permanent closure of at least one provider. The survey finds that states’ initial plans for the new American Rescue Plan Act’s (ARPA) 10 percentage point temporary increase in federal Medicaid matching funds for HCBS center on provider payment rate increases and workforce recruitment — two areas which recent experience confirms are crucial to sustaining and expanding access to long-term care services at home and in the community.

The new survey report 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 ARPA funding. The funding is available from April 2021 through March 2022.

Just under half of the states that responded to the survey said they were tracking COVID-19 vaccination rates among Medicaid HCBS enrollees. At the same time, state HCBS programs are playing a role in facilitating vaccine access for HCBS enrollees, with most responding states adopting multiple policies in this area. Over one-third of responding states have publicly available data on COVID-19 cases and deaths among HCBS enrollees.

The ARPA enhanced funds are available only for one year. The budget reconciliation package proposed by Democratic leaders in Congress aims to expand funding for HCBS, though the details will be worked out by Congressional committees. President Biden earlier this year proposed a $400 billion federal investment in Medicaid HCBS, though it is unclear how much of that funding increase will be approved by Congress as it considers competing priorities in the budget package this year.