A pandemic relief package that was expected to funnel $12.7 billion to states to bolster Medicaid home and community-based services actually distributed nearly three times that much in extra funding, the White House says.

In 2021, Congress approved a temporary funding bump for home and community-based services as part of the American Rescue Plan, a $1.9 trillion bill passed in response to the COVID-19 pandemic. The extra dollars came in the form of a 10% rise in the federal government’s share of spending on the program between April 2021 and March 2022.

Now, the Biden administration says that interest in the funding far exceeded expectations. About $37 billion has been distributed across all 50 states for the Medicaid program, which many people with developmental disabilities rely on for support to live in the community.

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The announcement came as the White House convened lawmakers from the state and federal level and advocates focused on caregiving issues at an event this week.

States were given significant flexibility to use the additional home and community-based services funds, but they had to be spent on services that were not available before April 2021.

Most of the money — nearly $25 billion — is going toward efforts to retain, expand and train the direct care workforce, the Centers for Medicare and Medicaid Services said, through pay increases, bonuses and other efforts in every state. Funding is also being allocated for workforce training, steps to ensure that services are high quality and toward reducing or eliminating waiting lists for home and community-based services, among other priorities.

CMS has given states until March 31, 2025 to use the funds.

Disability providers have seen the additional funding as a lifeline while they have dealt with ongoing workforce shortages and other challenges in recent years. A survey of providers across the nation last year found that 83% were turning away new referrals and 63% had discontinued offerings because of staffing issues — problems that most anticipated would get worse as COVID-19 relief funding and regulatory flexibilities expired.

In addition to touting the distribution of funds, the Biden administration also issued new guidance this week detailing best practices for states to develop online registries to connect direct support workers with those who need care. Officials said that states can qualify for funding to develop and maintain the registries.

U.S. Sen. Bob Casey, D-Pa., who has introduced legislation to extend the investment in home and community-based services, said that more needs to be done to ensure the program remains successful long-term.

“The temporary increase in funding provided by the law has helped to provide tens of thousands of Americans with home care, reducing wait lists and increasing care options while also raising wages for direct care workers. However, if we do not take action to make these temporary investments permanent, all these gains may be lost,” Casey said.

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