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Emergency Pandemic Funding for HCBS for People with IDD

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 CategoryAverage % Increase
Financial support services33.0%
Health and professional services27.8%
Community transition supports26.1%
Family services24.6%
Supports to live in one’s own home23.7%
Supported employment22.2%
Residential habilitation20.4%
Specialized medical equipment and assistive technology20.2%
Day habilitation20.0%
Adult day health17.7%
Support coordination16.7%
Self-advocacy training and mentorship12.1%

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

Map of average % increase reimbursement rates by state ranging from 0% to 60% (district of columbia). Values for each state are available in a table in the full journal article.

“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).

This article is a summary of the following journal manuscript: Friedman, C. (2022). A Report on the Increased Payment Rates for HCBS for People with Intellectual and Developmental Disabilities During the COVID-19 Pandemic. Journal of Developmental and Physical Disabilities, 1-20.