The variety of states with ready lists for individuals needing dwelling and community-based providers (HCBS) hasn't seen a lot variation between 2016 and 2024, in keeping with a brand new information evaluation from KFF.

Since 2016, there have been roughly 700,000 individuals on ready lists or curiosity lists in most years.

The whole variety of registrations on ready lists elevated by 2.6% between 2023 and 2024. There are at present greater than 710,000 individuals on ready lists.

Taking a look at particular person states, we see a lower within the variety of individuals on ready lists in 14 states, and a rise in 19 states.

KFF's evaluation discovered that a few of these adjustments could possibly be defined by some states not screening for Medicaid eligibility earlier than placing individuals on these lists.

“Modifications to this coverage could lead to adjustments to waitlist volumes,” KFF wrote. “For instance, between 2018 and 2020, the whole variety of individuals on ready lists fell by 155,000 or 19%. Nevertheless, practically half of that change got here from Ohio's implementation of a waitlist overview of waiver eligibility, which diminished the dimensions of the state's waitlist by practically 70,000 individuals.”

As of 2016, greater than half of the individuals on waitlists have been situated in states that don’t display for eligibility.

“One purpose why waitlists present an incomplete image of want is that not all individuals on waitlists are eligible for providers,” KFF wrote. “Interviews about HCBS waitlists revealed that when waiver providers are supplied on a first-come, first-served foundation, individuals on waitlists anticipate future wants.”

The KFF evaluation additionally supplied perception into the individuals on these ready lists.

Individuals with mental and developmental disabilities made up 89% of waitlists in states that didn’t display for eligibility, and 49% in states that didn’t display earlier than inserting somebody on the listing.

Moreover, seniors and adults with bodily disabilities made up 24% of the waitlists.

When it comes to common wait time, individuals on ready lists usually accessed providers after about 40 months. It is a lower from 45 months in 2021, however a rise from 36 months in 2023.

As federal funding for HCBS from the American Rescue Plan Act (ARPA) begins to dry up, addressing waitlists could turn out to be tougher, in keeping with KFF.

“ARPA funding to scale back or remove waitlists and that persevering with these reductions is a high precedence,” KFF wrote. “Nevertheless, it’s unsure what number of ARPA initiatives shall be sustainable in the long run as extra federal funds are exhausted.”

Extra ARPA funding will finish in March 2025 in most states.

Nevertheless, the way in which states deal with waitlists might quickly change because of federal coverage.

The “Guaranteeing Entry to Medicaid Companies” rule requires larger transparency and reporting from authorities companies relating to waitlists.

“The truth that CMS is requiring some extra uniform nationwide reporting on what's occurring in states with these waitlists is a big profit to people, well being care suppliers and policymakers making an attempt to enhance the system,” mentioned Damon Terzaghi, senior director of Medicaid Advocacy on the Nationwide Alliance for Care at Residence, beforehand informed Residence Well being Care Information. “CMS is de facto asking itself: How many individuals are on these ready lists, and the way lengthy do they wait between the time they’re positioned on the listing and the time they really obtain providers. That could be a big step ahead.”