In October 2023, the TA Collective brought together 18 HCBS thought leaders — comprised of state officials, home and community-based services (HCBS) advocacy leaders, people with lived experience and their caregivers — for a day-long meeting in Denver to discuss the challenges facing the HCBS system and approaches to building on the successes of the ARPA HCBS initiatives.
While the ARPA infusion of dollars into HCBS provided an historic opportunity to try bold, new approaches to supporting people in their homes and communities, it is imperative to not lose momentum. The current structure of Medicaid, and HCBS in particular, often serves as a barrier to modernization; moreover, the institutional bias within Medicaid poses an ongoing challenge to the true realization of HCBS as a viable option for all.
Summit attendees offered an abundance of thoughtful considerations for improving, expanding, and enhancing HCBS, focused on the broader systems changes necessary for advancing HCBS guided by these principles:
- Our nation’s LTSS system must prioritize the preference of most people in the U.S. to live in HCBS settings.
- People with lived experience must have a voice in efforts around HCBS.
- HCBS must be the first option offered to individuals, and the system must have capacity to serve all individuals who choose it.
- Operating HCBS must be made simpler and more understandable for all partners in the system.
- HCBS must be available to all, regardless of how they communicate, their backgrounds, and their cultures.
- Congress, CMS and states must create a space for new ideas and sharing across the country.
In addition to the Summit report itself, a technical supplement is available which provides details on the Summit itself, as more expansive discussion of the HCBS system and the challenges it faces.