ARPA HCBS TA Collective Release Report

NASDDDS, ADvancing States, and our partners in the American Rescue Plan Act (ARPA) home and community-based services (HCBS) Technical Assistance Collective (TA Collective) are proud to release a report sharing findings about states’ experience in implementing their ARPA HCBS initiatives.  While the ARPA infusion of federal dollars into HCBS provided an historic opportunity to try bold, new approaches to supporting people in their homes and communities, states were challenged to make systemic improvements given the time-limited nature of the federal funds.

To gather insights into states’ experiences in implementing their ARPA HCBS spending plans, the TA Collective fielded a national survey in early 2024 that aimed to identify successful strategies used by states implementing their ARPA HCBS spending plans, as well as any barriers hindering their success. Based on responses to that survey, this report highlights the challenges and barriers states faced in thoughtfully executing their initiatives in the midst of a public health emergency.  The thirty-three states that responded to the survey shared the top barriers to implementing their projects as planned. These barriers include:

• Delays in obtaining approval from CMS for both their spending plans and the necessary federal authorities to implement those plans;
• Lack of staff capacity to design and implement complex initiatives;
• The time it takes to complete state procurement processes to implement projects; and,
• The need to secure legislative approval and/or budget authority before beginning work.

The report also suggests ways to make any future time-limited investments in the HCBS system more effective, including giving states more time to implement; easing the CMS approval process; and, providing resources to both states and CMS. Moreover, any future investments should be accompanied by a federal evaluation to glean insights into successful interventions that could be replicated across the country.

While this report highlights challenges and lessons learned, it should be noted that, against all odds, states created transformational change with their ARPA spending plan initiatives. Our hope is that this report — and the recommendations contained therein — serves as a roadmap for any future federal investment in the HCBS system.

This report is also informed by the TA Collective’s work supporting states with their ARPA initiative planning, implementation, and evaluation activities and by observations and analysis of state and federal ARPA HCBS activities. It builds upon the TA Collective’s past work including, Efforts to Evaluate the Impact of ARPA HCBS Investments, an issue brief examining state evaluation approaches, and a summary of the work of the HCBS Sustainability Summit, which provided valuable context on sustaining the HCBS commitment fostered by ARPA investments. The newest report can be found here. Both reports can be found here.

We are grateful to The John A. Hartford Foundation, the Care for all with Respect and Equity (CARE) Fund, The SCAN Foundation, and the Milbank Memorial Fund for their support in making the work of the TA Collective possible.

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About the ARPA HCBS Technical Assistance Collective

The ARPA HCBS Technical Assistance Collectivebrings together four organizations with deep expertise in HCBS systems: ADvancing States, Halperin Health Policy Solutions, the National Association of State Directors of Developmental Disability Services (NASDDDS), Riverstone Health Advisors, as well as Brian Burwell. The TA Collective’s mission is to support states as they strive to maximize the impact of the unprecedented HCBS funding available under the American Plan Rescue Act.  The TA Collective has been working with states on their ARPA HCBS initiatives since October 2021 and has delivered project management support, direct technical assistance, and shared learning opportunities to states.

The National Association of State Directors of Developmental Disabilities Services (NASDDDS) (www.nasddds.org) represents the nation’s I/DD agencies in 50 states, the District of Columbia, and Puerto Rico providing services to children and adults with intellectual and developmental disabilities and their families. NASDDDS promotes visionary leadership, systems innovation, and the development of national policies that support home and community-based services for individuals with disabilities and their families.

ADvancing States (www.advancingstates.org) represents the nation’s 56 state and territorial agencies on aging and disabilities and long-term services and supports directors. ADvancing States supports visionary leadership, the advancement of systems innovation and the articulation of national policies that support long-term services and supports for older adults and people with disabilities and their caregivers.

Halperin Health Policy Solutions (www.halperinhealthpolicysolutions.com) is an independent consulting firm that provides state and federal government agencies, non-profits, and provider organizations with direct assistance related to healthcare and long-term services and supports (LTSS) access and coverage issues for lower-income older adults and persons with disabilities.

Riverstone Health Advisors (www.riverstonehealthadvisors.com) consults to state and federal agencies, health plans, vendors, and providers as they strive for success in government healthcare programs, including Medicaid home and community based services (HCBS) and other Medicaid long-term services and supports (LTSS) programs, Medicaid managed care, and Veterans’ healthcare, among other programs.

Brian Burwell is an independent contractor and nationally recognized expert on HCBS policies and programs.   He served as a Commissioner on the Medicaid and CHIP Payment and Access Commission for six years.   His career has been focused on Medicaid policy for older persons and persons with significant disabilities.