End of Pandemic-Era Policies in Medicaid Home- and Community-Based Services Could Challenge Family Caregivers and Enrollees

Family caregivers played a key role in supporting people who used Medicaid home- and community-based services (HCBS) during the COVID pandemic. Many states used new pandemic-era authorities to support and pay family caregivers and maintain services in other ways amid workforce shortages and other challenges. Now, several states are ending payments to family caregivers and unwinding other pandemic-era policies, which could complicate ongoing workforce shortages and create new challenges for enrollees, according to survey of state Medicaid HCBS officials from KFF.

Although many states are strengthening their HCBS programs by making COVID-era policies permanent, other states are bringing them to an end. Among the most common policies expiring, virtual evaluations of people’s eligibility and care needs will end in 23 states, increased utilization limits on existing services will end in 21 states, and prior authorization requirements will be reinstated in 19 states, which may make it harder for Medicaid enrollees to access HCBS.

Pandemic-era workforce policies will also end in a handful of states, which could exacerbate ongoing workforce shortages as some payment rates return to lower levels and fewer family caregivers are paid for their time. The end of family caregiver payments will be most common for people with intellectual or developmental disabilities and for people who are ages 65 and older or have physical disabilities.

Over 4 million people use Medicaid HCBS, KFF estimates. To be eligible for these services, individuals must have limited financial resources and significant functional impairments.

The 50-state survey of state Medicaid HCBS officials was conducted between May and August of 2023.