Our Work

State Strategies to Increase HCBS Provider Capacity


Home- and community-based services (HCBS) allow people with significant physical and cognitive limitations, many of whom are dual eligible individuals, to live well and independently in the community. As states work to rebalance the proportion of Medicaid beneficiaries in institutional versus community-based settings, individuals are increasingly receiving HCBS. However, despite this growing reliance on HCBS, there is a national shortage of workers and overall capacity to deliver such services to beneficiaries, limiting the ability of state Medicaid agencies to provide adequate services to individuals in the community.


With support from Arnold Ventures, ATI Advisory evaluated managed Medicaid LTSS (MLTSS) Requests for Proposals (RFPs) and MLTSS and Dual Eligible Special Needs Plan (D-SNP) contracts (or State Medicaid Agency Contracts) from eight states to identify strategies to promote HCBS capacity building in partnership with managed care organizations (MCOs). We produced a tool that identifies strategies to address HCBS capacity building goals through MLTSS RFPs and MLTSS and D-SNP contracts. Example RFP or contract language was included if available.


States have broad flexibility to encourage and require MCOs to support HCBS capacity building efforts. Collaboration and partnership between MCOs and states can help address HCBS provider and capacity shortages to better support beneficiaries to thrive in their communities.


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