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Office of Community Living outlines LTSS spending surge and proposes utilization limits, rate alignments and DD‑waiver enrollment changes
Summary
HCPF’s Office of Community Living told the committee LTSS spending has grown rapidly and that utilization and recent wage‑driven rate increases together explain most of the trend. OCL proposed a package of measures (soft yearly HCBS caps, 56‑hour weekly provider limits, caps on legally responsible persons' homemaker hours, rate alignment for certain residential settings, PEDI for residential services, and DD waiver enrollment changes) intended to slow growth while preserving community care.
Bonnie Silva, director of HCPF’s Office of Community Living, told the Joint Budget Committee the state faces unsustainable LTSS cost growth and presented a multi‑part proposal to slow trends while preserving access to community services.
Silva said LTSS spending is driven primarily by utilization (roughly 46% of recent trend), rate increases tied to workforce wage investments (about 43% of trend) and enrollment changes. The agency cited a net OCL budget of just over $5 billion total funds with about 50% federal match and said projected LTSS spending will rise another $2.17 billion in FY26‑27 absent corrective action.
To reduce growth, HCPF proposed targeted measures in the governor’s supplemental request and R‑items: a soft annual HCBS cap across personal care, homemaker and health maintenance activities; a 56‑hour weekly limit on hours any single paid caregiver can bill for a given member (the member may receive more hours but from multiple caregivers); limits on homemaker hours billed to legally responsible persons (parents, spouses) to 5 hours/week; unit limits for community connector and a 260‑hour annual cap for community connector; alignment of individual residential services and supports (IRSS) billing to remove billing anomalies where family homes were billed at staffed‑home rates; applying post‑eligibility treatment of income (PEDI) to residential settings; and changes to automatic enrollment from children’s waivers into the adult DD waiver (auto‑enrollments to be limited to child welfare cases).
Silva emphasized numerous guardrails: exceptions and emergency pathways for individuals with extraordinary needs, a case‑by‑case review process, and investment in staffing to handle additional administrative work (appeals and reviews). She also stressed that many OCL proposals are aimed at addressing extreme outlier utilization patterns rather than removing core services: ‘‘92 percent of all HCBS members will experience no change to the programs they are currently enrolled in or the services that they receive,’’ Silva said. The department promised follow‑up materials with family‑level hypotheticals and said it would provide targeted outreach and a robust stakeholder process before regulation or rule changes take effect.
What happens next: HCPF asked the committee to consider proposed items as a package; if enacted, several changes would require regulatory revisions, implementation systems work, and targeted member communications. The department committed to return with example household‑level modeling showing dollar impacts under illustrative scenarios.
Speakers (selected): Bonnie Silva (Director, Office of Community Living), Kristen Bates (Behavioral Health director), Kim Bimstefer.
