Assessing Disparities in Medicaid Home- and Community-Based Services: A Systematic Review

Lawren E. Bercaw
Abbie Levinson
Douglas Fletcher
Sari B. Shuman
Stephanie Hughes
Sachin Peddada
Edith G. Walsh
Peer-Reviewed Article
June 2022


While there is limited research on whether Medicaid home and community-based services (HCBS) are available, accessible, accommodating, and acceptable for marginalized groups, existing evidence shows that there are widespread disparities that policymakers should address.


Medicaid HCBS deliver person-centered care to support older adults and people with disabilities to continue living in their homes. While Medicaid must cover institutional care, Medicaid HCBS are optional and vary widely based on geography. These programs have expanded significantly in recent years and will likely continue to grow. This systematic review describes disparities by personal characteristics such as race and ethnicity in HCBS programs related to availability, accessibility, accommodation, and acceptability.


While there is limited research on disparities in HCBS, the authors conclude that service disparities are widespread within Medicaid HCBS. The wide variation in Medicaid HCBS programs and eligibility, along with the historic prioritization of institutional care, has led to variation in availability, access, accommodation, and acceptability.


As policymakers expand access to Medicaid HCBS, they should consider key steps to address disparities in these programs such as improving data collection, identifying geographic areas to reach individuals with unmet needs, and reducing stigma through mandating Medicaid coverage of HCBS.

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