Projects
Exploring Self-Direction Models for Home- and Community- Based Services
2024-2025
Project Overview
Objective
To asses states’ use of Medicaid authorities to provide self-directed home- and community-based services (HCBS) programs to identify potential policy strategies for future consideration.
Project Motivation
The national shortage of direct care workers who provide HCBS to Medicaid beneficiaries is a longstanding issue. Building on previous MACPAC work on Medicaid payment policies to support the HCBS workforce, MACPAC aims to develop a foundational understanding of the self-directed HCBS landscape to inform future work.
Prepared For
Medicaid and CHIP Payment and Access Commission
Mathematica is conducting a qualitative study for MACPAC to inform meaningful policy solutions to address the HCBS direct care workforce shortage and expand access to HCBS.
The purpose of the study is to understand the range of state approaches to designing and administering self-directed HCBS. Three research questions guide the work:
- What is the statutory and regulatory framework that guides self-direction?
- How do states design and administer self-directed programs for HCBS?
- What barriers to effective program administration exist for self-directed HCBS?
To explore these questions, we are interviewing several individuals and organizations with expertise in self-directed HCBS such as federal officials, national associations, advocacy organizations and research institutions. We are also inviting a select group of stakeholders – including state agencies and other third-party entities that participate in self-direction models – to discuss the design and administration of these models. These include information and support professionals, support brokers, case management entities, financial management services (or FMS) agencies, and managed care organizations. MACPAC will include the findings from this work in presentations to the Commission and potential future publications.
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