States are facing challenges meeting their obligations to provide home and community-based services to people with developmental disabilities and other groups, federal investigators say.

A report examining 26 Medicaid offerings across five states reveals that everything from funding to the needs of beneficiaries are threatening access to community-based living.

The findings come from an audit conducted by the nonpartisan Government Accountability Office.

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Investigators looked at home and community-based services in Arizona, Florida, Mississippi, Montana and Oregon, evaluating programs and interviewing state Medicaid administrators as well as managed-care providers.

Officials cited difficulty recruiting and retaining direct care workers due to low pay as well as trouble serving people with significant medical or behavioral issues in community settings, the report found. Additionally, administrators indicated that they’re working with limited funds to meet a growing population of people who need care in the community.

Meanwhile, factors like a lack of affordable housing and state pressures to limit per-person spending on home and community-based services present obstacles, GAO found.

States have made efforts to overcome these issues such as raising worker pay, allowing family members to be paid as caregivers and leveraging federal grants and other funding sources, GAO indicated.

In their findings, GAO investigators note that home and community-based services now account for more than half of Medicaid spending on long-term care, reaching $94 billion in 2016. But, program offerings, administration and spending on such services vary widely across the country.

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