American Rescue Plan Act: Extra Funding for Home and Community-Based Services

ARPA HCBS funding details

President Biden signed ARPA into law on March 11, 2021. The act provides a total of $1.9 trillion in economic stimulus to aid the recovery from the COVID-19 pandemic. Of the $350 billion earmarked for state, local, tribal, and territorial governments, Wisconsin is receiving $2.5 billion.

Section 9817 of ARPA gives qualifying states a temporary 10% increase to their federal matching percentage on specific home and community-based services from April 1, 2021, through March 31, 2022. The Wisconsin Department of Health Services (DHS) is using ARPA funds to strengthen our HCBS programs, address direct care workforce issues, and develop strategies to delay the need for long-term care. The Centers for Medicare & Medicaid Services granted conditional approval of the plan, allowing Wisconsin to start claiming the increase. We have until March 31, 2025, to invest approximately $350 million in funding.

State initiatives

Nine strategic initiatives led by DHS and funded by ARPA represent much-needed investments to help our most vulnerable state citizens live their best lives.

Medicaid HCBS Rate Reform

We rolled out a 5% rate increase for home and community-based services on January 1, 2022. It applies to multiple service providers who work with Medicaid programs, like Family Care, Family Care Partnership, IRIS, PACE, the Children’s Long-Term Supports Program, SSI Managed Care, BadgerCare Plus Managed Care, and Medicaid Fee for Service.

Wisconsin’s frail elders and people of all ages with disabilities rely on HCBS to meet their daily needs. HCBS are a cost-effective alternative to higher-cost institutional services, such as nursing home care or hospital services. Higher reimbursement rates allow HCBS providers to better recruit the staff who are critical to providing care to our members.

Currently, this project looking to establish a minimum fee schedule for select HCBS services.

---

Direct Care Workforce Reform and Analysis

Wisconsin’s direct caregiving workforce is the backbone of HCBS. To better recruit, support, and retain these vital workers, we are using ARPA funds to:

• Conduct workforce surveys to assess turnover, tenure, wages, benefits, and other factors.
• Implement a tiered-rate career ladder for personal care and supportive home care workers that rewards professional advancement.
• Expand career opportunities through a statewide professional credentialing and continuing education system.
• Design a statewide registry of direct care workers. It will include credentialing details plus specialty education and expertise, so individuals who need care can search for qualified direct care professionals to meet their needs.

---

Grant Opportunities

A new grants initiative is creating opportunities to strengthen HCBS programs. Currently, over 100,000 children and adults receive HCBS services in Wisconsin. The grants will direct new resources to some of the most pressing issues faced by this population. Grants are assisting providers with COVID-19 recovery and improving, enhancing, and expanding their services.

See awarded projects by viewing the ARPA HCBS Grant Awards Dashboard.

---

Tribal Long-Term Care Enhancements

Members of Wisconsin’s tribal nations should have access to services that address their unique cultural and policy needs. Wisconsin recently completed a survey of all 11 tribes to identify their home and community-based service system needs. DHS is now working with each tribe to develop a plan to use ARPA funds to meet those needs. In addition, we are making arrangements to fund an aging and disability resource specialist for each tribe.

---

Independent Living Supports Pilot

Many Wisconsin residents who don't require long-term care services or are not currently eligible for Medicaid could benefit from short-term, flexible supports to stay independent and healthy. For example, home modifications or small amounts of supportive home care or respite care would allow more people to remain in their own homes. This would help ease the increased burden on Wisconsin’s long-term care system as our population ages.

DHS is collaborating with stakeholders to implement a pilot program. The pilot will offer short-term, flexible, and limited services and supports for people at risk of entering Medicaid long-term care. This pilot will provide invaluable insight about how people seek information about services and supports. It will also help us understand potential barriers in accessing those services.

---

Aging and Disability Resource Center Modernization

Aging and Disability Resource Centers (ADRCs) serve older adults, adults with disabilities, as well as caregivers and professionals in the community. An ADRC provides unbiased information on a broad range of programs and services, helps people understand the various long-term care options available to them, helps people apply for programs and benefits, and serves as the access point for publicly-funded long-term care. To further support their work, DHS will:

• Develop a statewide online network for customers to review resources in their community, ask questions about services available to them, and provide a point of contact for their local ADRC. This online resource network will provide an additional, accessible way to review services provided in local, in-person offices throughout the state.
• Explore creating an online resource portal for members of Medicaid long-term care programs to manage their program benefits, allowing ADRCs to focus on other priorities.
• Invest in ADRC outreach and education to connect those in need with information on what an ADRC can do, as well as connect them with a referral source.

---

No Wrong Door – Supporting Kids Together

Families of children with delays or disabilities should be able to find programs and services easily, no matter which county they live in or where they go for help. The “no wrong door” approach means that no matter where or how a family reaches out, they will be able to connect to the resources they need to thrive. A resource hub team will coordinate between systems and provide targeted support for unique situations. The initial focus will be connecting children newly identified with special needs to programs such as Children’s Long-Term Support, the Birth to 3 Program, Children’s Community Options, and Katie Beckett Medicaid.

---

Assisted Living Reporting, Assessment, and Certification

DHS wants to make it easier to collect data on and track certification of assisted living settings where IRIS and Family Care participants get care. Making these improvements will make the certification process faster and more secure, and  help us make well-informed decisions on programs and policy. As our state’s aging population grows, this becomes more and more important. We plan to:

• Create an online tracking system for certifying 1-2 bed adult family homes. Key features include multiple levels of access to review information, upload documents, and update statuses. This includes portal access for IRIS adult family home providers and MCOs. They will also be able to set up their own accounts and manage certification information.
• Create a secure, online system to review potential HCBS setting providers. Key features include an online application for DHS to administer standard and heightened scrutiny reviews of these settings. The online system also includes portal access for providers to create their own accounts and view statuses, manage documentation, and update applications and plans.

---

Adult Incident Reporting System

Ensuring the health and safety of people using HCBS services is critical. Improved coordination between state provider licensing, medical services, and protective services will increase safeguards for vulnerable people. DHS will explore the development and implementation of a system to support increased coordination, with an initial focus on adult long-term care.

---