Herb Kohl: “As you and many other Senators are aware, home- and community-based services, or HCBS, are critically important to…”

“As you and many other Senators are aware, home- and community-based services, or HCBS, are critically important to millions of older and disabled Americans who rely on Medicaid, which today is our country's most important publicly financed system for nursing home care and home-and community-based services. But there is a critical difference in the legal status of these services. Under Federal law, nursing home services are a mandatory benefit that must be offered by all States to all individuals who meet stipulated eligibility criteria. In contrast, HCBS services are not a mandatory benefit. Rather, they are offered by States under waiver programs granted by the U.S. Department of Health and Human Services for limited time periods and for limited numbers of individuals. States across the country have obtained multiple HCBS waivers over the last 20 or so years. These HCBS programs tend to be extremely popular, often because they provide a considerably wider array of nonmedical support services than are otherwise offered under the Medicaid statute. The State of Wisconsin has invested a great deal of time and effort in their waiver programs, many of which have been very successful. Nevertheless, because waiver programs are capped in terms of the number of beneficiaries who can be enrolled, there has been substantial growth in the size of waiver waiting lists, which in Wisconsin reached an unacceptably high level of more than 11,000 people.”