Research to Improve the Quality, Impact, and Value of Home and Community-Based Services

Nearly eight million Americans use Medicaid home and community-based services (HCBS) to support long-term services and supports for people with disabilities. Recent legislative changes to Medicaid will require states to make difficult choices about how best to meet these long-term services and supports needs. This paper first characterizes the unique goals of HCBS, which differ from those of traditional medical care services, and the state-federal financing and administrative structure of HCBS. Next, based on a review of the literature and input from a panel of experts in HCBS policy and research, we summarize existing evidence and knowledge gaps regarding the quality and cost implications of HCBS at the federal, state, and direct service provision levels. Based on gaps in the evidence, we propose a research agenda related to state-federal incentives, state program choices regarding HCBS financing and delivery models, and the settings and supports for direct service provision. Finally, we describe existing and novel data sources and other opportunities that could accelerate research to fill these evidence gaps and support states and others in designing, implementing, and delivering sustainable, high-quality HCBS.