By Carli Friedman, CQL Director of Research
During the COVID-19 pandemic states made temporary changes to their Home- and Community-Based Services (HCBS) programs using Appendix K to improve the quality of services. This included temporarily increasing their reimbursement rates for services. The aim of this study was to examine how states changed their reimbursement rates for HCBS for people with intellectual and developmental disabilities (IDD) during the pandemic. To do so, we analyzed 294 Appendix K waivers (March 2020 to April 2022) that applied to IDD HCBS.
Between March 2020 and April 2022, states increased reimbursement rates for 2,500 different HCBS services for people with IDD. Reimbursement rate increases ranged from a 3.5% increase to a 160.7% increase, with an average rate increase of 23.3%. However, increased reimbursement rates appear to have been decreasing since April 2021 (see full study for more information).
The service categories that saw the largest increases during the pandemic were financial support services (33.0%), respite (31.5%), and health and professional services (27.8%). Meanwhile, the smallest increases were for self-advocacy training and mentorship (12.1%), support coordination (16.7%), and prevocational services (16.7%).
|Service Category||Average % Increase|
|Financial support services||33.0%|
|Health and professional services||27.8%|
|Community transition supports||26.1%|
|Supports to live in one’s own home||23.7%|
|Specialized medical equipment and assistive technology||20.2%|
|Adult day health||17.7%|
|Self-advocacy training and mentorship||12.1%|
There were also large differences across states and waivers. While the District of Columbia (60.4%), Alaska (50.0%), Kentucky (50.0%), Michigan (50.0%), North Dakota (50.0%), Utah (50.0%), and Washington (50.0%) had the largest average reimbursement rate increases, the following states did not increase their reimbursement rates for IDD HCBS using Appendix K: Arkansas; Florida; Iowa; Kansas; Mississippi; Montana; Nevada; New Jersey; Ohio; and South Dakota.
Average Increased Reimbursement Rates by State
“The increased funding provided through Appendix K represents an influx of billions of additional dollars into the HCBS IDD service system. While this funding was desperately needed during the pandemic, it also means that, since Appendix K is a temporary authority, after the public health emergency (PHE) is over, funding for HCBS for people with IDD will reduce dramatically… It remains to be seen how the IDD service system will reconcile with returning to pre-pandemic reimbursement rates, especially as the HCBS IDD system was underfunded and fractured prior to the pandemic” (Friedman, 2022, p. 15).
Emergency Pandemic Funding Improved the Continuity and Security of People with IDD
The aim of this study was to examine if states’ expanded pandemic payments translated to improved continuity and security among people with IDD during the pandemic. To do so, we analyzed Personal Outcome Measures® interviews from 738 people with IDD and Appendix K data reimbursement data from the 16 states the people with IDD lived in.Continue Reading