Examining the Impact of ARPA Funds on Racial Equity and Home and Community-Based Services

The 2021 American Rescue Plan Act (ARPA), also known as the COVID-19 Stimulus Package, provided state programs and individuals with varying degrees of short-term financial relief. Funds were distributed with the goal of supporting communities and individuals who had been hit especially hard by the pandemic.    

One such program states received an influx of money to support during the COVID-19 pandemic was home and community-based services (HCBS), HCBS supports people with Medicaid live independently by bringing essential medical and non-medical services into their homes and communities. People receiving HCBS are primarily those who have intellectual or developmental disabilities, physical disabilities, and/or mental illnesses.  

The federal government estimated that states would spend over $25 billion on HCBS; with the goal to enhance, expand, and strengthen these programs and services. This project examined how states did, or did not, equitably use ARPA funds to enhance, expand or strengthen HCBS. 

Our Partnership Approach to Advancing Racial Equity and Health Justice
A Partnership Approach to Advancing Racial Equity and Health Justice in Home and Community-Based Services  

When the the American Rescue Plan Act (ARPA) passed in 2021, it sent a much-needed infusion of funding to state, local and tribal governments reeling from a global pandemic. We’re still seeing the benefits of the law in the form of boosted tax credits available during the 2023 open enrollment, a growing coalition of states cementing the 12-month postpartum Medicaid coverage spearheaded by ARPA and offered to states indefinitely under the omnibus bill, and guaranteed no-cost coverage for COVID-19 vaccinations for insured people.

But, as most advocates know, the design and implementation of policy can be two radically different things. Passage of ARPA was a reason for celebration in the health justice community and beyond, but attention in many places turned to the nitty gritty of ensuring the funds would reach communities who needed them the most.   

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Community Engagement and Equity in ARPA HCBS Spending Plans 

State of ARPA Funding

Community Engagement and Equity in ARPA HCBS Spending Plans 

Section 9817 of the American Rescue Plan Act (ARPA) provides states with a temporary ten percentage point increase to the federal medical assistance percentage (FMAP), amounting to a total of $12.7 billion in spending increases available. As a result of the increased FMAP and in response to stakeholder feedback, states are taking direct action to address HCBS access and quality issues, many states are prioritizing initiatives that strengthen the direct care workforce.

States have now gotten approval for and published their initial spending plans, which provide important insights into each state’s process in engaging community input and articulating their equity goals. Beyond the specific HCBS policy initiatives of each state plan, this analysis will investigate two aspects of the spending plan development and implementation process: community engagement and equity. While initial spending plans are not an exhaustive representation of all states efforts regarding equity and community representation in HCBS spending, they are important to identify within the parameters of the ARPA spending opportunity.

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Learning from Key Informants

Learning from Key Informants

When ARPA was signed into law, the Centers for Medicare and Medicaid Services (CMS) encouraged state to include robust stakeholder engagement and good faith public notice in their spending plans for the billions in additional funding provided to states and local jurisdictions. While specific requirements remained loose, CMS emphasized engagement beyond facilities, plans, and providers. Specifically, states were encouraged to engage family members, caregivers, aging and disability networks, and the direct support workforce. The extension particularly emphasized the need to address barriers to care and the workforce crisis with home and community-based services.  

Concurrently, states navigated significant and mounting barriers to making progress on equity and community engagement in their ARPA spending plans including aggressive timelines and a lack of infrastructure. However, robust examples of states finding creative and innovative approaches to bolster equity and engagement in home and community-based services still exist. These states represent a diversity of geography, political landscapes, and communities of HCBS beneficiaries. 

To understand the experiences of state policymakers in their HCBS spending through their ARPA allocated dollars, Community Catalyst spoke with a group of national key informants. These key informants have been involved in home and community-based services (HCBS) ARPA spending planning and implementation in various capacities, including advocacy and providing technical assistance to state policymakers. 

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Resources

Did ARPA Investments in Home and Community-Based Services Reach Those Who Needed it Most?

In March 2021, HCBS programs across the country received additional funding through the American Rescue Plan Act (ARPA). This funding was designed to provide immediate aid in a very short window of time and, true to its intent, this year, Vice President Harris announced that ARPA investments in HCBS had reached approximately $37 billion across all 50 states. President Biden’s ARPA spending package included historic and unprecedented investments in HCBS. With the influx of funds came immense opportunity and a new set of challenges. In the limited time they had, how successful were states and municipalities in allocating these funds in a way which addresses inequities in HCBS? The new CMS data and report may be able to give us some additional insight into this.

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Advancing Racial Equity and Health Justice in Home and Community-Based Services: Community Catalyst’s Partnership Approach

The design of policy and the implementation of policy can be two radically different things and even the best policy will falter and fail without guidance and advocacy by the people and communities programs aim to help. This was the impetus behind new work for the Center for Community Engagement in Health Innovation at Community Catalyst, with support from the CARE For All with Respect and Equity Fund, on a project to promote the equitable implementation of the ARPA funding set aside to support HCBS. Through a participatory action model, we aim to engage communities, prioritize their preferences and ensure that federal funding for HCBS is utilized effectively.

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We Worked Hard to Get ARPA Funding to Support Home and Community-Based Services: Then What Happened?

It’s almost hard to believe that it’s been over two years since President Biden signed the American Rescue Plan Act into law. The trillion-dollar spending package alleviated some of the chaos COVID-19 inflicted on our health and economy and sent a much-needed infusion of funding to state, local and Tribal governments reeling from a global pandemic. What can we learn from the impact of ARPA funding on home and community-based services (HCBS) to ensure such funds reach communities who need them the most.

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