In The News

A Closer Look At The Millions Of People On HCBS Waiting Lists

Home Health Care News / By Patrick Filbin
More than half a million people across the U.S. were on state waiting lists for home- and community-based services (HCBS) in 2021.
But the number of states that have a waiting list for people who are in need of HCBS is the lowest it’s been since 2016 at 37.
However, HCBS waiting lists are often incomplete and sometimes inaccurate, making it difficult to quantify the unmet need for the services financed through Medicaid waivers.
In 2021, about 656,000 people were on HCBS waiting lists, according to the Kaiser Family Foundation (KFF). That’s lower than the nearly 820,000 individuals that were on Medicaid waitlists for HCBS in 2018.
Home- and community-based services are a way to fill gaps in care for seniors with complex medical conditions. Medicaid is often the main source of coverage for long-term services and supports (LTSS).
There are well over 2 million individuals receiving HCBS services, but the way waiting lists are calculated can be an unscientific process that can both overstate and understate unmet needs, according to KFF.
For example, not all states screen for Medicaid eligibility before adding people to HCBS waiting lists. That can inflate the number on a waiting list by adding people who may never be eligible for services.
In its most recent analysis, KFF found that over half of people on HCBS waiting lists lived in states that did not screen people on waiting lists for eligibility.
The only HCBS that states are required to cover is home health care, but states can choose to cover personal care and other similar services.
Waiting lists can also understate need. States choose which populations they serve through the Medicaid waiver and what resources they will commit.
People may need services, but if the state doesn’t offer them — or doesn’t offer them to people over 65, for example — those individuals would not appear on a waiting list.
“Even though HCBS waiting lists are an imperfect measure of unmet need, there are no other measures available,” KFF wrote in its summary. “Therefore, waiting lists remain a source of concern to policymakers, and proposals to eliminate them have been put forth by both Republicans and Democrats.”
Takeaways from KFF analysis…

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CMS Pressures States to Adhere to Upcoming HCBS Rule Deadline

McKnight’s Home Care / By Liza Berger

[Last] Thursday [was] the cut-off for states to submit corrective action plans (CAPs) for their home- and community-based services (HCBS) programs in advance of the March 17 HCBS regulatory deadline. But the Centers for Medicare & Medicaid Services is concerned that states are dragging their heels on the CAPs.

“Today’s conversation is in the name of information sharing, technical assistance, reiterating expectations that we are a partner in adhering to the settings regulation, and yet we’re quite serious that it needs to have meaning and beneficiaries need to be able to see their lives reflected in the in the words in the regulation,” Melissa Harris, deputy director for the Disabled and Elderly Health Programs Group, said earlier this month, according to the Inside Health Policy news outlet.

The warning comes as HCBS stakeholders have voiced concerns that a majority of providers are turning away referrals because of limited staff capacity, and the workforce crisis is putting a severe strain on resources. CMS officials have been adamant that workforce shortages are not a justification for not meeting basic civil right requirements such as access to food and freedom to have visitors.

If states anticipate they will be unable to come into compliance with the final rule by March 17, they have until Dec. 1 to submit CAPs, CMS has said. States’ CAPs should include details on which criteria they need more time to complete — excluding criteria that protect basic civil and constitutional rights.

In May, CMS issued a recalibrated strategy to help states comply with the HCBS final rule and the March 17 deadline.

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More than 90% of COVID Deaths Occurring Among Elderly Adults: CDC

ABC News / Mary Kekatos

Older people have always been known to be one of the groups at highest risk of death from COVID-19, but they now make up a larger share than ever before.

As of the week ending Nov. 19, Americans aged 65 and older make up 92% of all deaths from the virus, according to data from the Centers for Disease Control and Prevention.

It's the first time senior citizens have made up more than nine out of 10 deaths since the pandemic began and a drastic increase from the roughly 58% of deaths they made up in summer 2021, an ABC News analysis shows.

An infectious disease expert told ABC News the data showcases the lack of boosters received by the older population and how the impact of the disease is hitting the most vulnerable as protection mounts in the population.

"The bottom line is that age is the most powerful risk factor for COVID deaths and we've known that all along," Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco, told ABC News. "At this point in the pandemic, it's not enough to just get a vaccine series. So, what it reflects is the failure of the older age group to get boosters."

As of Nov. 24, just one-third of people aged 65 and older have received the bivalent boosters, CDC data shows.

The updated booster specifically protects against the omicron subvariants BA.4 and BA.5, currently making up about 20% of infections in the U.S.

While this percentage is higher than most other age groups, Chin-Hong said it's still quite low for a group at high risk of severe illness and death.

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A Common Treatment for Your Knee Osteoarthritis May be Making it Worse, Studies Say

CNN / By Madeline Holcombe

A common treatment for some arthritis pain might actually be making the condition worse, according to two new studies.

“Knee osteoarthritis is one of the most chronic, degenerative and progressive conditions, with an estimated incidence of 800,000 patients each year in the US alone,” said lead author of one of the studies, Dr. Upasana Bharadwaj.

Osteoarthritis is a common form of arthritis where the cartilage within a joint breaks down over time and the bones around it change, getting worse over time, according to the US Centers for Disease Control and Prevention.

At least 10% of the patients in the study used injections to manage the pain, added Bharadwaj, who is a postdoctoral research fellow in the department of radiology at the University of California San Francisco’s School of Medicine. Two of those pain management injectables are corticosteroids, the more common of the two, and hyaluronic acid.

The studies, which were presented at the annual meeting of the Radiological Society of North America, used either radiograph or MRI images to track the progression of osteoarthritis in the knees of patients. Some of those patients didn’t receive any treatment and others got corticosteroid or hyaluronic acid injections, according to the studies.

Both papers showed a statistically significant increase in progression of degenerative changes in knee cartilage over two years in people that had corticosteroid injections compared with those who had hyaluronic acid or no injections, according to the study authors.

However, just because the images might look worse doesn’t always mean that the people are feeling more pain, said Azad Darbandi, lead author of the other study.

“You might see that the knee looks bad on a radiograph, but the patient might not be having worse symptoms,” added Darbandi, a researcher and medical student at the Chicago Medical School of Rosalind Franklin University of Medicine and Science.

The studies highlight a debate in the osteoarthritis scientific community about the role of changes in the structure of the joint. Currently, pain is the primarily recognized symptom, said Jason Kim, the Arthritis Foundation’s vice president of osteoarthritis research. Kim was not involved in either study.

The takeaway from the studies is that corticosteroids should be administered with caution for osteoarthritis pain.

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Team USA Players Share Emotional Embrace with Iran’s Saeid Ezatolahi

Fox Sports / By Martin Rogers

[We all need a feel good story. Here’s one to get your week started on the right “foot”!]

He’d given everything, and this time, it hadn’t been enough. As the final whistle at Al Thumama Stadium signaled a 1-0 United States victory, there was nothing left for the Iran defensive midfielder to do. So, he sat on the turf, deep into the Qatari night, buried his head in his hands and let the tears tumble.

Seconds later, he felt a big arm around his shoulder. It was Josh Sargent, the USA forward, who had dueled with him during a first half in which the Americans desperately chased a goal until one came after 38 minutes via Christian Pulisic.

Sargent kneeled next to Ezatolahi, hugged him and offered some words of kindness and sympathy. Soon after, USA substitute Brenden Aaronson noticed the scene, saw the anguish on the Iranian player’s face, and came over, too. As did DeAndre Yedlin.

Tim Weah joined them. As he approached, Weah’s face changed from one of beaming delight to something more solemn. As Ezatolahi tried to collect himself, Weah took him by the hands and pulled him to his feet, before hugging and whispering in his ear.

"I think it’s more than just football," Weah told me, as he left the stadium to return to the team’s Doha headquarters. "I think the United States and Iran have had so many issues politically and I just wanted to show that we are all human beings and we all love each other. 

"I just wanted to spread peace and love and show him we come from different backgrounds, we grew up differently. He is still my family, he is still my brother and I love him the same way as the guys I grew up with." 

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