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What Happens to HCBS When the Public Health Emergency Ends?

By Carli Friedman, CQL Director of Research

The COVID-19 pandemic significantly impacted the quality of life of people with intellectual and developmental disabilities (IDD) and the human service industry. In recognition of the significant impact the pandemic has had on services and supports for people with IDD, many states temporarily amended their Medicaid HCBS programs for people with IDD to try to maximize the quality of services and minimize the impact on people with IDD. To make these changes, states submit Appendix K: Emergency Preparedness and Response Waivers to the Centers for Medicare and Medicaid Services. In Appendix K waivers, states outline what changes they will make to their HCBS programs during the pandemic.

The aim of this study was to examine how HCBS programs for people with IDD were changed during the pandemic. To do so, we analyzed 294 Appendix K waivers (March 2020 to April 2022) that applied to IDD HCBS.

Most Common Temporary Changes to IDD HCBS During the Pandemic

Amendment% of states
Modify provider requirements95.6%
Add remote/electronic service delivery93.3%
Expand settings where services may be provided93.3%
Increase payment rates88.9%
Modify processes for level of care re/evaluations82.2%

Least Common Temporary Changes to IDD HCBS During the Pandemic

Amendment% of states
Increase the number of people with IDD eligible to receive HCBS4.4%
Modify population eligibility for waivers13.3%
Institute/expand opportunities for self-direction13.3%
Increase cost limits for entry into the waiver26.7%
Authorize case management entities to provide direct services28.9%

See the full journal article to find out more about all of the changes made during the pandemic, as well as information about which changes specific states made.

“Appendix K waivers are temporary amendments to state HCBS waivers. Many of the amendments to HCBS IDD programs found in this study are scheduled to revert to pre-pandemic operations 6 months after the Public Health Emergency (PHE) is terminated [on May 11, 2023], unless approved by other authorities or implemented into the states’ actual 1915(c) waivers. Given the changes made using Appendix K waivers aimed to promote the access, continuity, and quality of HCBS, we believe it would be beneficial for many of the changes made to waivers via emergency authorizations, such as introduction of telehealth, expansion of paying family caregivers, increased reimbursement rates for DSPs, and increased flexibility in service provision, to continue… It is important to ensure quality HCBS continue for people with IDD during the pandemic and well beyond” (Friedman, 2022, p. 13).

This article is a summary of the following journal manuscript: Friedman, C. (2023). Emergency COVID-19 pandemic changes to Home-and Community-Based Services for people with intellectual and developmental disabilities. Inclusion, 11(3), 179-192.