August 18, 2021
By federal definition, Home and Community-Based Services (HCBS) in North Carolina include the Medicaid waiver programs of Innovations, Community Alternatives Program – Disabled Adults (CAP-DA) and Community Alternatives Program – Children (CAP-C). Despite having these focused programs in North Carolina, according to the NC Waiver Action Team, the average wait time in our state is 9.5 years for waiver services as compared to an national average wait time of 3 years. President Biden made a commitment to focus on this issue and the result is the introduction of the Better Care Better Jobs Act in both the House of Representatives as HR 4131 and the Senate as S 2210. The NC General Assembly has also taken action within their budget proposals to address some of the outstanding issues.
The federal plan has included bold strategies to address the shortcomings in HCBS. Most importantly, the legislation will infuse $400 billion to reimburse for HCBS services. This will be accomplished by permanently increasing by 10 percentage points the amount of federal Medicaid match for services. Medicaid services are paid for through a federal and State match. For example, if the federal match is 60%, then the federal government will pay 60 cents of every Medicaid dollar and the State is responsible for the remaining 40 cents. By increasing the federal match amount, State’s have less dollars to contribute themselves.
The legislation also calls for addressing the direct care workforce payment rates. The Kaiser Family Foundation stated in a 7/16/21 article that home care workers earned on average $11.52 per hour, or $16,200 per year, in 2018. This has led to workforce shortages. The NC General Assembly included in both the House and Senate budget proposals an increase to $15 per hour rate for direct care workers. The Better Care Better Jobs Act will also provide incentives to provide innovation, quality and accountability. The Money Follows the Person program will be made permanent with a $400 million appropriations. The bill also includes permanent spousal impoverishment protections.
In addition to increasing the direct care workers hourly pay rate, the NC House budget proposal includes the creation of the HCBS Fund with $274.8 million of funding saved from the federal appropriations through the American Rescue Plan Act (ARPA). The Fund can be used to increase the number of waiver slots in the Innovations and CAP waivers in the future. Both the House and Senate budget proposals for NC include an increase by 1,000 slots of the Innovations waiver.