The Center for Personal Assistance Services (PASC) has issued a report titled Home and Community-Based Services: Public Policies to Improve Access, Cost, and Quality that offers suggestions for improving policy at both the state and federal levels.

The report identifies numerous problems in the current Medicaid HCBS structure, including inequities in access to services, inadequate provider wages and benefits, and inadequate training requirements for direct-care workers.

The report concludes with an overarching statement about the need for Medicaid restructuring, saying that “Ultimately, many of the problems of inequities in access to HCBS, inequities in expenditures, and quality problems are related to limited funding for HCBS and the decentralized state administration of the Medicaid program. . . . Legislation could be undertaken to merge the Medicaid LTC program into the Medicare program to create a combined Medicare and Medicaid LTC program.”

Dorie Seavey, PHI’s Director of Policy Research, contributed to the development of the PASC report.