(Letter to the Editor - Photo Illustration - MetroCreativeConnection)

As policymakers in Washington, D.C., consider the future of essential disability services in West Virginia, it is imperative that we recognize their profound value. Protecting and expanding HCBS is not just about compassionate care; it’s about investing in the well-being of all West Virginians and the economic vitality of our state.

Medicaid Home and Community-Based Services are a crucial lifeline and a smart investment for people with Intellectual and Developmental Disabilities, their families, and West Virginia’s economy. New research provides compelling evidence that HCBS yields significant positive economic and societal impacts, demonstrating that they are not merely an expense, but a powerful engine for community well-being and growth.

One of the most profound societal benefits of HCBS is its ability to enable people with IDD to live fulfilling lives within their own homes and communities, rather than in more costly and often isolating institutional settings. This preference for community-based living is widely shared by Medicaid beneficiaries, who, like all of us, desire to participate fully in their communities and have control over their daily lives. In West Virginia, HCBS allows 11,882 disabled people to live, work, and participate in communities across the state. Studies show that families receiving HCBS report a higher quality of life and notable improvements in the skills and employment status of people with IDD. Individualized support services and therapeutic interventions provided by HCBS directly contribute to these outcomes.

Beyond enhancing West Virginians’ lives, HCBS also generates tangible economic benefits for our state. HCBS waivers contribute significantly to state economic growth and job creation. Missouri’s Partnership for Hope HCBS waiver, specifically designed for individuals with IDD, is a prime example. This program contributed almost $22.2 million to Missouri’s gross state product and was responsible for more than 435 jobs. HCBS programs are also remarkably cost-effective. The average per person cost for state institutions in 2009 was $188,318, compared to just $42,486 for Medicaid-funded HCBS. In Missouri’s case, every $1 spent by the state and its counties on the PfH program leveraged $5.31 in federal funds for supports and services.

These policies also boost our local labor market and help people with disabilities and caregivers have gainful employment. HCBS waivers have been found to increase the likelihood that parents of children with autism will be able to continue working, reducing the need for them to stop employment to care for their child. This not only supports the financial stability of families, but also boosts overall economic productivity.

Moreover, HCBS addresses critical health care needs and disparities. Studies indicate that Medicaid HCBS waivers significantly decrease the unmet health care needs of children with autism, particularly those who might not otherwise qualify for Medicaid. Community-based services, such as respite care and home and community aide services, also decrease the risk of psychiatric hospitalizations for children, adolescents, and young adults with autism. For example, a $1,000 increase in respite care spending was associated with an 8% decrease in the odds of hospitalization.

Despite these clear benefits, Medicaid and HCBS are facing some of their biggest threats in history. Home care is classified as an “optional benefit” in West Virginia, making it susceptible to deep cuts if Congress moves forward with cutting federal investment by nearly $800 billion. The fragility of the system is underscored by existing waiting lists, with 766 West Virginians currently awaiting HCBS. Federal cuts to Medicaid would have devastating consequences, forcing states to reduce services and directly impacting their economies and citizens. In West Virginia, proposed cuts could lead to 69,186 people losing health insurance, an estimated loss of 6,500 jobs, and a reduction of $666.3 million in state GDP in 2026 alone. Such cuts could also shutter rural hospitals and undermine efforts to recruit and retain much-needed staff in care facilities and impose new hurdles, like stricter eligibility checks and work requirements, that disproportionately affect eligible individuals and increase administrative costs.

The evidence is clear: Medicaid and HCBS are an effective and efficient mechanism for improving lives, fostering community integration, and stimulating economic growth. We must do everything we can to protect it.

Doug Hess

Chief Operating Manager

The Arc of West Virginia