From $1 trillion in Medicaid cuts courtesy of the One Big Beautiful Bill Act to workforce shortages, Medicaid home- and community-based services are under pressure.
KFF evaluated payment rates, provider closures and staffing issues through a 2025 survey. All states, except for Florida, responded, and the survey included the District of Columbia. States generally completed the survey prior to the budget law’s enactment.
Here are four takeaways from the survey’s findings:
1. Every state reported home care worker shortages, with the lack of direct support professionals, nursing staff, personal care attendants and case managers being the most pressing.
2. All states said they are attempting to tackle these workforce shortages. Increasing payment rates was the most common strategy, followed by furthering training programs and offering incentives for recruiting and retaining workers.
3. Over the last year, 41 states documented permanent closures of home care providers. Adult day health program closures were the most common, occurring in 28 states.
4. Many states struggled to report hourly payment rates, which they will be required to do starting in July. Some said the bundling of services and the use of managed care plans complicated reporting, and others said they knew agency rates but not worker rates.
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