title: Medicaid home- and community-based services: impact of the affordable care act.
abstract: The Affordable care Act (ACA) legislation of 2010 has three important voluntary provisions for the expansion of home- and community-based services (HCBS) under Medicaid: A state can choose to (1) offer a community first choice option to provide attendant care services and supports; (2) amend its state plan to provide an optional HCBS benefit; and (3) rebalance its spending on long term services and supports to increase the proportion that is community-based. The first and third provisions offer states enhanced federal matching rates as an incentive. Although the new provisions are valuable, the law does not set minimum standards for access to HCBS, and the new financial incentives are limited especially for the many states facing serious budget problems. Wide variations in access to HCBS can be expected to continue, while HCBS will continue to compete for funding with mandated institutional services.
authors.affiliation: Department of Social and Behavioral Sciences, University of California, San Francisco, CA 94118, USA. Charlene.Harringon@ucsf.edu
authors.forename: Charlene
authors.initials: C
authors.lastname: Harrington
authors.forename: Terence
authors.initials: T
authors.lastname: Ng
authors.forename: Mitchell
authors.initials: M
authors.lastname: Laplante
authors.forename: H Stephen
authors.initials: HS
authors.lastname: Kaye
mesh_terms: D000368:Aged; D005380:Financing, Government; D006291:Health Policy; D006699:Home Care Services / Q000191:economics*; D006792:House Calls / Q000191:economics; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration*; D008484:Medicaid; D009313:National Health Programs; D009735:Nursing Homes / Q000191:economics*; D058991:Patient Protection and Affordable Care Act; D012946:Social Welfare / Q000191:economics*; D014481:United States