Understanding and Responding to Inequities in Access to, Utilization, and Quality of Medicaid Home and Community-Based Services

Friendly nurse supporting an eldery lady

Medicaid Home and Community-Based Services (HCBS) serve the most medically and economically vulnerable groups. Consequences of inequities to HCBS can be severe, including higher mortality and higher avoidable institutionalization among racial and ethnic minorities and geographically disadvantaged people (those living in rural areas and areas not covered by relevant Medicaid HCBS).

Support for this work was provided by the AIR Equity Initiative.

While HCBS serve populations across different types of disability, age, race, ethnicity, and location, most knowledge about the diversity of HCBS populations is limited to descriptive demographic information.

About the HCBS Project

The descriptive statistics descried above do not account for confounding factors, such as service needs, and can be misleading without a systematic investigation of disparities in the three aspects of HCBS—access, utilization, and quality—by race and ethnicity. This project aims to address this critical knowledge gap and improve HCBS equity.

Key Objectives

  1. Measure. Systematically investigate if, and to what extent, there are racial and geographic inequalities and inequities in access to, utilization of, and quality of Medicaid HCBS.
  2. Understand. Account for the reasons for any observed disparities.
  3. Respond. Engage diverse stakeholders, including policymakers, to develop collaboratively strategies that will address the disparities. 

Research Questions

  1. What are the disparities and inequities in HCBS access, utilization, and quality? 
  2. What are the facilitators of and barriers to equity in HCBS? 
  3. How can we respond to inequities in HCBS?  

Populations of Focus

  • Seniors (adults aged 65+)
  • Adults with physical disabilities
  • Adults with intellectual/developmental disabilities served by Medicaid HCBS
Aditi Pathak headshot
Senior Economist
Kelsey Walter headshot
Senior Researcher