Investing in HCBS

Dear Editor,

Most people don’t know what Home & Community Based Services (HCBS) are, let alone their importance to many disabled people. People who are physically disabled often depend on others to perform “activities of daily living” like getting in and out of bed, dressing, bathing, preparing meals, toileting and transferring to and from a wheelchair.

If you are physically and financially eligible, a state’s HCBS program, usually funded by Medicaid, will pay for assistants to come to your home.

But states don’t always supply the needed resources and applicants languish, sometimes for years, waiting to get the services they need.

Vermont’s Medicaid-funded HCBS program is called Choices for Care.

One definition of infrastructure is the basic systems and services, needed to function effectively. For many people who are physically disabled, that is exactly what HCBS services do. So I was delighted to learn that President Biden’s $2 trillion American Jobs Plan proposed investing $400 billion in the “infrastructure of care,” defined as “the policies, resources, and services necessary to help U.S. families meet their caregiving needs… [including] home- and community-based services and supports.”

This commitment to home and community-based services throughout the country would “solidify the infrastructure of our care economy by creating jobs and raising wages and benefits for essential home care workers.”

Some people oppose treating in-home care as “infrastructure.”

Mike Ervin, an outspoken disability rights activist, says, “That’s because the ability of disabled folks to live rich lives in supportive communities is of no importance to them. So HCBS does not register in their small imaginations as important infrastructure.”

Funds from the American Jobs Plan could make needed improvements to Vermont’s Choices for Care program.

Currently Vermont caregivers are paid a wage just above the minimum wage, which reduces the pool of people willing to do this vital work and, consequently, the quality of the care given.

The program also requires that applicants be impoverished; they must shed assets that could be used to maintain a home, a car, an accessible van, or the purchase of food for a specialized diet. Income from work can result in loss of Medicaid eligibility, hence eligibility for the Care program.

I hope the American Jobs Plan funds could also be used here in Vermont to bolster and revitalize the Participant Directed Attendant Care program. It’s not Medicaid based, does not require that assets be shed, and does not discourage employment.

Charlie Murphy

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