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Home and Community-Based Services Enhanced Funding: Section 9817 of the American Rescue Plan Act of 2021

Key Takeaways:

  • Home and Community-Based Services (HCBS) can help improve people’s health, independence, and quality of life by offering care in the home or community rather than in an institutional setting.
  • Under Section 9817 of the American Rescue Plan Act of 2021, Vermont claimed an additional $69 million to enhance, expand, and strengthen Medicaid HCBS; the state will leverage these funds to implement activities valued at approximately $155 million between April 2021 and March 2025.
  • Vermont’s HCBS Spending Plan Narrative outlines the state’s plan for how to use these funds. This document is updated semi-annually.

What are Home and Community-Based Services?

HCBS include medical and non-medical services that are provided in a home or community-based setting rather than an institutional setting. A variety of populations, including people of all ages with intellectual or developmental disabilities, physical disabilities, mental health conditions, or substance use treatment needs, receive HCBS to assist with daily living. Examples of HCBS include home health care, personal care services (dressing, bathing etc.), case management, and substance use disorder treatment. HCBS are offered through a variety of programs, including but not limited to the Choices for Care Program, Developmental Disability Services, Brain Injury Program, Community Rehabilitation and Treatment Services, and Mental Health Under 22.

What is Section 9817 of the American Rescue Plan Act of 2021?

Signed into law by President Biden on March 11, 2021, Section 9817 provides states with additional federal funding for Medicaid HCBS. States received a time-limited 10 percentage point increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures from April 1, 2021 to March 31, 2022. Vermont claimed $69 million in increased funding that will be used as the state share required to implement activities valued at approximately $155 million. These funds must be spent between April 1, 2021 and March 31, 2025. This is an unprecedented opportunity to enhance, expand and strengthen HCBS under the Medicaid program. 

How will Vermont use the HCBS FMAP funding?

Vermont’s plan for the HCBS FMAP funding is outlined in the Vermont HCBS Spending Plan Narrative, which is updated semi-annually. The most recent version of the Plan can be found here:

Vermont HCBS Spending Plan Narrative Update, submitted July 2022

Examples of activities in the Vermont HCBS Spending Plan Narrative include:

  • Provider rate increases
  • Increased limits or caps on assistive devices and home modifications
  • Workforce recruitment and retention activities, such as the Premium Pay Program and bonuses for independent direct service providers
  • Housing and residential service regional pilot planning grants
  • Pilot programs for emergency room alternatives and supportive housing assistance
  • Strengthening assessment and person-centered planning processes
  • Grants to providers to support quality improvement
  • Investments in data systems 

The initial plan was submitted by the Agency of Human Services (AHS) to the Centers for Medicare and Medicaid (CMS) on June 14, 2021. AHS then received input on the Spending Plan through an initial public hearing and public comment period. A summary of these comments can be found here. AHS will continue to collect public comment and stakeholder input throughout the investment period. Vermont received partial approval of the State’s Initial Plan in July 2021 and full approval in May 2022. Earlier versions of the Spending Plan can be found here:

CMS Letters and Responses

For more information about the HCBS FMAP programs, please reach out to AHS.HCBSFMAP@vermont.gov.

Updates on HCBS Enhanced Funding will be posted to the Global Commitment Register (GCR). Please see GCR 21-039 and GCR 22-075 for public notices on HCBS Enhanced Funding. If you would like to be notified when new Medicaid policies are posted to the GCR, please email AHS.MedicaidPolicy@vermont.gov and request to be added to the GCR listserv.

Page last updated August 1, 2022.