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Changing the Landscape of Home and Community Based Services

Home and Community Based Services (HCBS) include a broad range of supports for people who have disabilities. The goal is that people will be able to access supports in integrated settings, to help make sure they live in their communities, have opportunities to explore their interests, and build careers. HCBS has been in the news a lot lately because of work in Congress to make investments and changes in HCBS. Here is a breakdown of the bills:


American Rescue Plan Act of 2021 (ARPA): 

Passed in March 2021  

The Federal Medical Assistance Percentage or FMAP is an amount of money that Congress gives to states to cover the federal share of Medicaid costs. Typically in Minnesota, we get $1 from the federal government for every $1 of state funds spent. The ARPA raised our FMAP by 10%, which means Minnesota will get $488 million more for HCBS from April 1, 2021 to March 31, 2022. The recently passed Health and Human Services (HHS) omnibus bill determined how to spend some of the increased HCBS FMAP funding in Minnesota. Funds must be spent by March 31, 2024. 


American Jobs Plan or Better Care Better Jobs Act: 

Proposed in June 2021 

The latest proposal includes $400 billion for HCBS, which might be lowered to $200 billion. The bill, as is, would make the 10% FMAP increase permanent if states strengthen and expand access to HCBS, invest in the HCBS workforce, and show improvement over time. It would also permanently authorize anti-poverty protections for people whose spouses access Medicaid HCBS services. And, the bill would make Money Follows the Person—which helps people who have disabilities move out of institutions and nursing homes into their own homes and communities—a permanent program. This bill is still being negotiated by Congress and may change.


HCBS Access Act of 2021: 

Proposed in March 2021  

HCBS is still optional for state Medicaid programs. This bill would make HCBS required for all states, increasing access to HCBS and helping people who have disabilities live and work in their homes and communities. This bill would also eliminate waiting lists, expand coverage for rehabilitation services, work to reduce turnover for direct support professionals (DSPs) and Personal Care Assistants (PCAs) by increasing pay and benefits, provide support for family caregivers, and establish a basic set of services that all states must provide. 


Our Goals for HCBS  

The Arc Minnesota will always fight for policies founded in our values: human and civil rights; self-advocacy and self-direction; equity and belonging; and disability and racial justice. We want there to be innovative and transformational change to HCBS that promotes individualized, truly inclusive supports that are tailored to each person. Most importantly, it is essential to center people who have disabilities and their families in the development, implementation, and evaluation of these transformative policies. 

Any future bills related to HCBS should commit to transformational policy and truly change the status quo. Our state is an important example, as Minnesota used the enhanced FMAP funding in innovative ways such as Inclusive Childcare, a task force to phase out of subminimum wage, employment and community living transition grants, informed choice training development, and technology grants for people who access HCBS.  

Another major change was The Arc Minnesota’s Systems Transformation bill,which strengthened our state’s commitment to informed choice, informed-decision-making, and individualized services. These historic policy changes are just the beginning, and we will keep working to change our system and society to make sure people who have disabilities and their families can live with dignity and build belonging.  

Read more about The Arc Minnesota’s position statements here. 


\Written by Julia Burkstaller, The Arc Minnesota Public Policy Director