On March 11, 2021, President Biden signed into law the American Rescue Plan Act. Section 9817 provides enhanced federal funding for Medicaid home and community-based services (HCBS) and certain behavioral health services through a one-year 10% increase to the share of state Medicaid spending that is paid for by the federal government. This one-year increase in federal matching funds would result in new, time-limited dollars that can be invested in certain Medicaid HCBS and behavioral health services through March 2025. These services strive to enhance the quality of life and independence of people in their home and community. This is an exciting opportunity to further strengthen such services.
Massachusetts’ initial spending plan outlined a framework for investment that enhances, strengthens, and expands HCBS across MassHealth populations both in the short term and in the long term. Use of enhanced federal funding through Section 9817 of the American Rescue Plan Act (ARPA) will reinforce Massachusetts’ commitment to strengthen access, family and natural supports, person-centeredness, choice, and equity to HCBS for those with physical disabilities, intellectual and developmental disabilities, and behavioral health needs and for older adults.
To achieve these goals, the Commonwealth of Massachusetts has used a staged approach to propose a total investment of $1.1 billion (gross) $655 million (net), using an anticipated $655 million in enhanced new federal funding. These investments provide immediate funds to strengthen and stabilize the HCBS workforce, in addition to funding long term, structural impact, with a focus on strengthening and sustaining the workforce, enhancing the HCBS system, rebalancing towards community living and providing supports to members, their families, and their caregivers.
Investments tie to the three structural pillars:
- HCBS Workforce development and expansion, including programs to train, retain and professionally advance the paid workforce, and support the unpaid family and natural caregiver workforce;
- Access to and Promotion of HCBS that further rebalance toward community- based services with a focus on HCBS navigation, transitions to HCBS and diversion from facility-based settings, and services that enhance HCBS capacity and care models (e.g., support and streamline transitions between settings, PASRR enhancements, embedded options counselors in inpatient and facility-based settings, enhanced communication tools for families, consumers, and caregivers, etc.);
- Technology and infrastructure investments that augment the workforce and strengthen HCBS (e.g., data sharing, caregiver directories, and electronic and interoperable platforms, etc.).
Massachusetts Spending Plans and Narratives
For the initiatives of which CMS has already granted approval, Massachusetts continues to move forward with policy development and implementation, with a commitment to ensure successful outcomes and positive long-term impacts for individuals served by HCBS across the state.
With the submission of the most recent October 2022 Quarterly Spending Plan, EOHHS has committed to a total investment of $1.1B (gross) $655M (net), using the enhanced federal funding, to enhance, strengthen, and expand HCBS across MassHealth populations.
CMS requires states to report quarterly on the activities that the state has implemented and/or intends to implement to enhance, expand, or strengthen HCBC. Quarterly report organized by calendar year can be found below.
- Initial HCBS Spending Plan and Narrative - June 17, 2021
- July 2021 Quarterly Spending Plan and Narrative - July 16, 2021
- October 2021 Quarterly Spending Plan and Narrative - October 15, 2021
- February 2022 Quarterly Spending Plan and Narrative - February 22, 2022
- April 2022 Quarterly Report - April 8, 2022
Implementation of Initiatives for Providers, Community Members and Stakeholders
Provider Rate Enhancements: Reporting and Attestation Requirements for Payments provided under 101 CMR 447.00
To implement the immediate time limited across-the-board payment enhancements for the HCBS workforce included in Round 1, EOHHS filed regulations under emergency adoption, 101 CMR 447.00: Rates for Certain Home- and Community-based Services Related to Section 9817 of the American Rescue Plan Act. The time-limited rate enhancements are effective July through December 2021 with the goal of strengthening and stabilizing the state’s HCBS workforce in response to the COVID-19 public health emergency.
- 101 CMR 447.00: Rates for Certain Home- and Community-based Services Related to Section 9817 of the American Rescue Plan Act
Information regarding the allowable use of this enhanced funding can be found below. EOHHS agencies will issue additional guidance and information related to implementation in the coming days based on program/provider specific needs. Providers are encouraged to check this site regularly for updated information.
- For MassHealth Providers: Home and Community-Based Service Enhanced Rate Add-Ons using American Rescue Plan Act (ARPA) Funding
Providers will have until September 30, 2022 to expend the funds. As a condition of receipt of these additional funds, eligible provider agencies must complete an attestation by December 31, 2022 assuring EOHHS that they have used at least 90% of the funds for direct care workforce development, which could include hiring and retention bonuses and other categories of worker compensation. Additionally, provider agencies that receive enhanced funds are required to submit a spending report to EOHHS that accounts for how the enhanced funds were used by December 31, 2022.
EOHHS has procured a vendor to create a reporting and tracking portal to facilitate reporting requirements for these funds. The reporting and attestation form is now available to providers through the links below. Additional information regarding this initiative will be added to this page as available.
HCBS ARPA Grant Programs
EOHHS will utilize HCBS ARPA funds to provide grant opportunities to strengthen and sustain the workforce, support providers in investing in new technologies, rebalancing towards community living and providing supports to members, their families, and their caregivers. As grant opportunities become available, information on the grants, who is eligible and how to apply can be found here.
Grant Program to Support Provider Home and Community Based Service (HCBS and Human Services Workforce Development: EOHHS will award up to $42.5M in grants to support training, recruiting, and retaining initiatives that support provider home- and community-based services (HCBS) and human services workforce. This is one of several provider grants rolling out over the next six months, including the forthcoming Respite Innovation Grants and Provider Technology Grants. Any Massachusetts provider, education/training institution, community organization, existing workforce program, or private foundation can apply. Additional information and details on how to apply can be found here.
Hospital to Home Partnership Program: EOHHS has announced a two-year $3M program to promote partnerships. between hospitals and Aging Services Access Points (ASAPs) and to strengthen communication and coordination with community providers to promote institutional diversion and increase discharge rates from hospital to home. Eligible partnerships of ASAPs and acute care hospitals can use grant funds to embed ASAP personnel in hospitals, or for innovations to support hospital-to-home transitions. Additional information and details on how to apply can be found here.
EOHHS provided multiple opportunities for community feedback on ways to enhance, expand, and strengthen Medicaid home and community-based services (HCBS) and certain behavioral health services through one-time and time-limited investments. This section will continue to be updated with notices, meeting information, and documents related to community input.
EOHHS first met with the HCBS and behavioral health community about the American Rescue Plan Act on Wednesday, March 31, 2021.
On April 16, 2021, the Commonwealth issued a Request for Information (RFI) to gather community feedback on strategic areas for investment. Responses were due May 7, 2021. The Commonwealth received 203 proposals in response to the RFI. A summary document of the responses is posted below.
EOHHS met again with the HCBS and behavioral health community on June 8, 2021 to provide an overview of the Initial Spending Plan and the steps that are being taken to enhance, expand and strengthen HCBS.
Most recently, EOHHS met with the HCBS and behavioral health community on July 16, 2021 to share additional details on the implementation of funding for time limited rate enhancements outlined in the Initial Spending plan, provide a high-level overview additional investments.
Public Discussion Forums
EOHHS hosted a series of public forums providing an opportunity for Stakeholders to engage on key topics, themes and issues related to investments contemplated for inclusion in the October Quarterly spending plan. Materials shared during these forums can be accessed by clicking on the links below:
- September 27: Retaining and Building a High-Quality HCBS Workforce
- September 28: Supporting Access to and Promotion of HCBS Services