Washington, D.C. — Today, Easterseals CEO Kendra Davenport submitted testimony for the record to the U.S. Senate Special Committee on Aging advising that rising costs and upcoming Medicaid funding changes could weaken Home and Community-Based Services (HCBS), a system millions of people with disabilities and older adults rely on to live safely at home.
The hearing, “Aging in Place: The Impact of Community during the Holidays” underscored that HCBS are what allows people to avoid institutional care, remain connected to their communities, and receive support that helps them work, stay healthy, and live independently.
Easterseals told lawmakers that HCBS providers are reaching a breaking point. Costs for staffing, transportation, and basic operations have increased sharply, yet reimbursement rates have not kept pace. At the same time, states facing new Medicaid pressures are already considering cuts, and HCBS, because it’s optional under federal rules, is often the first to be reduced.
“HCBS is what allows people to live at home, stay connected to their communities, and remain in control of their lives,” said Kendra Davenport, President and CEO of Easterseals. “When these services are scaled back, the impact is immediate: caregivers are stretched thin, daily needs go unmet, and people are left without the supports that make independent living possible.”
Easterseals is urging federal leaders to take steps to protect HCBS, including directing states to maintain services and ensuring that people with disabilities and caregivers are properly exempt from upcoming community engagement requirements.
Read the full testimony below:
On behalf of the millions of people with disabilities served through 70 Affiliates in 48 states, Easterseals appreciates the opportunity to submit this statement for the record to the Senate Special Committee on Aging hearing “Aging in Place: The Impact of Community during the Holidays.”
The Holidays are a good time to reflect that Home and Community-Based Services (HCBS) through Medicaid are a success for 4.5 million Americans and their families. It lets people with disabilities remain at home and in the community; work; and be engaged, contributing members of society. The right of people with disabilities to live in the community has been reaffirmed through the Americans with Disabilities Act, the Olmstead decision, and more. Much of this progress is at risk of backsliding today.
From a policy perspective, HCBS continues to be a win-win, preserving people’s rights and producing significant fiscal savings for taxpayers. It costs Medicaid $36,275 per person to provide HCBS. In comparison, it can cost almost $400,000 a year for someone with a developmental disability to be in an institution in parts of the country. HCBS through Medicaid is also an important economic driver, supporting 2.4 million jobs. Every $1 the federal government spends on HCBS generates $1.17 in economic activity. HCBS also lets Easterseals participants like Zach in Indiana get a job preparing electronics for repair. HCBS also allows family members to stay in the workforce. Katie in Hawaii was able to keep her career as a financial advisor at a major bank because her son Bennett attends an Easterseals day program. This is the difference between thriving and poverty for millions of Americans.
Today, the public-private partnership between Easterseals and the government is under strain. Easterseals already fills in the gaps when HCBS through Medicaid falls short of the cost of care. The cost of wages, transportation, and rent has all gone up, but Medicaid reimbursement has lagged. In Florida, respite programs for caregivers do not authorize enough hours for a full workday. This means Easterseals Affiliates must absorb uncompensated costs to give family caregivers a day off.
Unintended consequences of forthcoming reductions in federal Medicaid spending mean that HCBS is under threat. HCBS is an “optional” service, meaning it is the first program states look to cut as they receive less federal funding. These cuts are already starting in places like Colorado, where paid family caregivers will receive 10% less next year. Providers will not even get a modest rate adjustment, resulting in reimbursement falling even further behind the cost of care. This is counterproductive for our shared constituents and for our country’s fiscal reality. A recent study showed that a 10% cut to HCBS in California would cost the state over $200 million more a year due to increased institutionalization.
We have come too far to go back. Delores, who is 95 and lives in Easterseals supportive housing in Indiana, was taken out of school during the Great Depression because other children bullied her for her disability. We no longer live in times where children are forced out of school or into institutions. Everyone should have the opportunity that Delores does today to be surrounded by family during holidays and to play with her cat “Beans.”
We are grateful for the robust bipartisan support on this Committee for HCBS. We must work together to strengthen HCBS. This can be done by asking the Centers for Medicare and Medicaid Services (CMS) to instruct states to preserve HCBS through a State Medicaid Director Letter.
We must also ensure that the Medicaid provisions of Public Law 119-21 are implemented as intended. This means correctly exempting people with disabilities and caregivers from the forthcoming community engagement requirements. A broad definition of medical frailty, permitting self-attestation paired with data matching, exempting people through ex parte verification, and reducing administrative burden are among the tools we should use to limit negative consequences.
Easterseals participants already face barriers every day. Lauren in Maryland does not have a salon in her area that can fit her wheelchair. Lauren is breaking down these barriers by seeking to open her own accessible salon. We do not need to create more barriers by making it harder for her to have healthcare and the supports she needs to thrive.
It’s particularly appropriate that this hearing is being held on the International Day of Persons with Disabilities. Let’s continue to ensure Americans can achieve their goals and live freely and safely in their communities. During a time of year when so many people face isolation, HCBS shows that a better way is possible. We thank the Committee for holding this hearing.
