Federal Medicaid officials are pushing states to do more to ensure that people with disabilities have access to the care they need in order to remain in the community.

In a bulletin issued this week, the Centers for Medicare & Medicaid Services is outlining a number of steps that states and disability service providers can take to ensure a strong home care workforce is in place.

The guidance comes as an increasing number of people with disabilities are receiving supports in the community rather than in institutional environments.

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Fiscal year 2013 marked the first time ever that more than half of Medicaid spending on long-term services and supports went toward home and community-based services. The latest figures show that 53 percent of such long-term care spending in 2014 was directed to community-based services, up from 45 percent in 2009.

“A stable workforce, engaged in the delivery of services and supports that address the needs and preferences of beneficiaries, is a critical element to achieving continued progress,” Vikki Wachino, director of the Center for Medicaid and CHIP Services, wrote in the bulletin.

States are being encouraged to consider establishing registries to help consumers find qualified home care workers in their area. The guidance indicates that federal funds are available to help develop and maintain such databases.

Meanwhile, the federal agency is also advising states to closely consider appropriate wages for home care workers. That may mean keeping in mind wage differences in various geographic areas within a state, the level of care provided by home care workers and business costs associated with recruiting, training and retaining people in the industry, the bulletin said.

In doing so, states have the option to set tiered rate structures in order to account for the ability of some workers to serve more complex needs, according to the document.

“Access to services is critical to ensuring that individuals get the care they need to live in the community, and wage thresholds help to attract dedicated and engaged workers,” Wachino wrote. “CMS encourages states and providers to be mindful of the relationship between wage sufficiency, workforce health and access to care.”