Medicaid Payment Policies to Support the Home- and Community-Based Services (HCBS) Workforce

HCBS workforce shortages reduce Medicaid's ability to serve people with long-term care needs in the home or community. Although some factors that affect the HCBS workforce are outside of Medicaid's purview, many states are exploring ways to use Medicaid rate setting to expand the HCBS workforce and reduce worker turnover. In previous MACPAC public meetings, staff discussed findings from a compendium of HCBS authorities, federal and state interviews, and a technical expert panel that explored strategies to ensure that HCBS payment rates are adequate to attract and retain a sufficient workforce. During this session, staff presented a draft chapter for the March 2026 Report to Congress and a recommendation to promote the HCBS workforce for a Commission vote.