The federal government giveth and taketh away, and this past May it declared an end to the COVID-19 public health emergency (PHE). This effectively ended a policy that provided states with new authorities to expand access to Medicaid caregiver payments.

The AP takes a look at the change and speaks with family caregivers worried over the future of Medicaid caregiver payments. It notes that a total of 39 states, with the help of the federal government, either started paying family caregivers or expanded the population eligible for payment during the pandemic.

Its reporting is based on a KFF policy watch that explores the potential implications of ending the PHE for Medicaid Home- and Community-Based Services (HCBS), including new or continued workforce challenges and potential reductions in patients’ access to care.

Findings in the KFF policy watch include:

• During the PHE, most states (39) reported responding to workforce challenges by allowing family caregivers to be paid, but only 20 states planned to continue that policy after the PHE ended.
• In a survey of states on Medicaid HCBS in 2022, many states reported using PHE authorities to bolster their HCBS programs by expanding eligibility and services and addressing workforce challenges.
• Looking ahead, the loss of PHE flexibilities could further exacerbate workforce challenges for HCBS programs.
• Unwinding the Medicaid continuous enrollment provision may create additional challenges for people who use HCBS.
• Longer-term it is unclear whether more significant changes for HCBS are possible, including potential changes that would attempt to reduce or eliminate HCBS waiting lists. On April 18, the White House issued a statement summarizing a series of executive actions that include provisions aimed at strengthening the HCBS workforce.

More than one in five Americans (21.3%) were caregivers in 2020, having provided care to an adult or child with special needs at some time over a 12-month period. In total, an estimated 53 million adults in the U.S. were caregivers, up from the estimated 43.5 million caregivers in 2015.

Photo: Wikimedia Commons