Mapping the Tools that States Use to Determine Eligibility and the Outcomes Associated with Home and Community-Based Services

Map of the United States showing the sources of information on Medicare waivers.

To qualify for vital public services, people with disabilities must demonstrate they need help with certain activities of daily living. But states have different ways of assessing these needs, and the process for qualifying for benefits is often opaque.

ICI’s Research and Training Center on Home and Community-Based Services (HCBS) Outcome Measurement (RTC-OM) recently launched a free, interactive national map of which tools that states use to assess whether people are eligible for HCBS as well as the manner in which states assess the outcomes associated with HCBS. The map, called the HCBS Assessment Tools database, appears on the RTC-OM website.

“Several states are redesigning their Medicaid waivers programs and they want to see what other states are doing,” said Matthew Roberts, an ICI research coordinator who is working on the project. The database is also viewed as important by staff at the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), who suggested its development; the Administration on Community Living; and the Center for Medicaid and Medicare Services, which funds home and community-based services so that they can track the manner in which states are making eligibility and funding decisions. This database will be updated frequently, which will help all stakeholders better understand the processes and tools that are being used to support equitable service provision.

To build the database, researchers spent several months digging into state applications for Medicaid waivers, comparing them to the actual processes states are currently using to determine eligibility for services. They examined both eligibility for receiving services and the level of funding for which individuals qualify. Then they verified the findings with state officials, Roberts said. Users can easily click through the states to see what assessment tools are used to determine eligibility, funding and support needs of people receiving services. Data on service quality and outcomes also is available.

“We believe this will help people start a conversation about the best way to assess needs, rather than each state operating independently,” he said. “This is the first time a resource has been developed to identify specific measurement tools being used within state HCBS programs across the United States.”