Coalitions Warn Against HCBS Cuts as Reconciliation Conversations and “Waste, Fraud, and Abuse” Actions Gain Momentum

The Partnership for Medicaid, a nonpartisan national coalition representing clinicians, health care providers, safety net health plans, and counties, is urging congressional leaders to take a targeted approach to Medicaid program integrity and avoid broad policies that could destabilize home and community-based services. A letter led by ANCOR and signed by a broad range of national health care and provider organizations, was sent to the leaders of the Senate Finance Committee and the House Energy and Commerce Committee and argues that reforms should focus on specific bad actors, rather than treating home and community-based services expenditures as broadly suspect. The coalition warns that sweeping cuts or overly broad fraud narratives could weaken provider networks and threaten access to the services on which millions of Americans rely.

The letter makes the case that home and community-based services have become a central part of Medicaid and of the broader shift away from institutional care. It notes that every state and the District of Columbia now funds these services, and that by 2022 home and community-based services accounted for 64.6% of Medicaid long-term services and supports spending. The coalition also highlights the stakes for people with intellectual and developmental disabilities (I/DD), pointing to data showing that supporting a person with I/DD in the community costs about $70,500 per year, compared to more than $395,000 in a public institutional setting.

At the same time, the coalition emphasizes that it supports strong oversight and enforcement. The letter points to existing federal and state anti-fraud structures, including the Office of Inspector General, the Department of Justice, state Medicaid Fraud Control Units, and managed care anti-fraud programs, and says policymakers should build on those targeted, evidence-based tools. It argues that this approach is especially important because the home and community-based services system is already under strain, with more than 600,000 people on waiting lists nationwide and average waits of 32 months.

Building on that message, the co-chairs of the Consortium for Constituents with Disabilities (CCD) Health Task Force and the Long-Term Services and Supports Task Force, and the Disability and Aging Collaborative (DAC) also sent a letter to congressional leaders underscoring the broader risks of additional Medicaid cuts or harmful policy changes. The letter urges House Energy and Commerce Committee leaders to reject any further reductions in Medicaid funding, arguing that states are already weighing cuts to home and community-based services as they absorb the effects of H.R. 1. The letter also stresses that home and community-based services are often among the first areas targeted when states face fiscal pressure, even as demand continues to grow, while waiting lists remain long, and the direct care workforce continues to face significant strain.