The COVID-19 pandemic presented a public health emergency that was unprecedented in its scope and duration and brought new focus to the long-standing unmet need for home and community-based services (HCBS) among seniors and people with disabilities and direct care workforce shortages. Recognizing Medicaid’s role as the primary payer for HCBS, this issue brief presents early findings from the most recent KFF 50-state survey of Medicaid HCBS programs. It focuses on state policies adopted in response to challenges posed by the pandemic, the pandemic’s impact on Medicaid HCBS enrollees and providers, and states’ early plans for the new American Rescue Plan Act (ARPA) 10 percentage point temporary increase in federal Medicaid matching funds for HCBS. We survey states about HCBS provided through state plan authorities and waivers. There were 277 HCBS waivers in FY 2018. Overall, 41 states responded to the survey by mid-July 2021, accounting for 87% of total HCBS spending nationally in FY 2018, though response rates for specific questions varied. We highlight some specific state examples where states provided additional information with their responses. Key finding include the following:

The state’s largest union of health care workers on Monday appeared to offer its support after Gov. Ned Lamont issued a vaccine mandate for the state’s nursing home workers last week.

In a statement, the head of SEIU 1199 New England said the union has been encouraging workers to get their shots since last December, when the vaccine first became available.

“The vaccine is an essential tool to protect workers and the people we care for every day,” said Rob Baril, the union’s president. “The Union is working with employers and with the State of Connecticut to make sure vaccination efforts are effective. We are looking into the details of Gov. Ned Lamont’s executive order for further discussions with employers to ensure effective implementation.”

Industry leaders of Connecticut’s long-term care facilities have already lined up to support the

Cynthia Macluskie has memories of her 3-year-old son sneaking out of their Cave Creek home late at night, while she was asleep. “At 6 o’clock in the morning, someone’s banging on my door. … I still get goosebumps from this,” she said, looking down at her arm during an interview.

A couple who’d woken up early for work found her son, Mark, and the Macluskies’ dog playing near a ravine, and the family’s address was on the dog’s collar.

That was more than 20 years ago. But Macluskie, vice president of the Autism Society of Greater Phoenix, said she knows other families might not be as lucky as she was that night when a loved one with a disability goes missing.

Mark was engaging in a behavior that’s common among youngsters on the autism spectrum: wandering or elopement – a tendency to run off from a safe area or caregiver. Research shows it’s common in about half of youth on the spectrum; 1 in 4 children are missing long enough to cause concern and are most in danger of drowning or traffic injuries.

“I think that happens more than we hear reported because people are embarrassed. They don’t want to admit that it happened,” said Macluskie, who shares her story as a cautionary tale. “That took a lot of ingenuity for him to get out of our house. He was pretty fast and pretty smart about it.”