Capitol Correspondence - 11.14.23

Providers Call for Enhanced Oversight of 1915(c) Waiver Applications

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In a unified effort, 164 organizations, primarily ANCOR members that provide Medicaid-funded Home and Community-Based Services (HCBS) to individuals with intellectual and developmental disabilities (I/DD) have collaborated to submit a sign-on letter to the Centers for Medicare and Medicaid Services (CMS).

Dated November 13, 2023, the letter addresses proposed changes to the Application for a 1915(c) Home and Community-Based Services Waiver (waiver application) and its corresponding Instructions, Technical Guide, and Review Criteria (technical guide), designated as CMS-8003.

While expressing gratitude for the opportunity to provide feedback on the proposed changes, the letter primarily emphasizes the need for comprehensive reviews and enhanced oversight by CMS. The organizations highlight specific concerns related to Appendix I-2-a of the waiver application and Item I-2-a of the technical guide, focusing on the inadequacy of instruction for states on demonstrating that their rate determination methods truly provide for adequate access to Home and Community-Based Services (HCBS).

The letter also addresses the ongoing direct support workforce crisis, emphasizing the critical need for fair wages and workforce stability to maintain quality services for individuals with I/DD. The organizations express concerns about the impact of the proposed changes on service availability, workforce retention, and potential closures.

As part of the sign-on letter, the organizations present compelling statistics from ANCOR’s surveys, highlighting the most recent direct care workforce crisis report, including a staggering 85.3% increase in service closures since the beginning of the COVID-19 pandemic.