Thread by @bethanylilly

A short 101 on Medicaid HCBS funding because I know it can be confusing to everyone. Medicaid is health insurance for the lowest income folks, which includes many people with disabilities. HCBS are the home and community based services people with disabilities can receive.

I say "can" receive because HCBS services are optional. Many services are mandatory, or required by the federal Medicaid law. HCBS are not. Often folks have to get on a waiver to access these services and waivers have waiting lists that can last decades.

This is partially because when Medicaid was created back in 1965, the traditional services provided to people with disabilities were institutional services--psychiatric asylums, facilities for people with physical or intellectual or developmental disabilities, etc.

These services usually mandatory, are built into the Medicaid system, and well reimbursed. Medicaid pays over $140,000 on average to serve someone in a facility for people with intellectual or developmental disabilities today.

In contrast, the same study found that it was just under $45,000 to provide people HCBS per year. Now, that's obviously not enough. We don't pay direct care workers a livable wage and have a massive workforce shortage.

But these are problems because we've had to advocate for every expansion of HCBS that exists today. Each new waiver, each new pilot has been a tiny movement towards building a comprehensive HCBS system.

We didn't start with a system in existence like the institutional system.

The Better Care Better Jobs Act acknowledges that we need to invest in the HCBS system to actually have quality services and end waiting lists. And even that isn't going to put the HCBS system on the same footing as institutional services. But it's a start!

And, because there seems to be some confusion on this point, investing in HCBS via the BCBJ Act doesn't hurt other services or take money away from other services. It's just investing needed funding in HCBS to make direct care jobs better and help people on waiting lists.