Several other states have been developing plans for such projects. States have provided funds to persons with disabilities to manage their own care through self-directed care programs. States are also consolidating formerly fragmented programs into more easily accessible financing and delivery systems. These gaps leave many policymakers reluctant to increase spending too rapidly on HCBC services. Some policymakers are uncertain about whether they will be substituting HCBC services for costly nursing home care or adding additional HCBC recipients while nursing home costs continue to rise.
Cost is a legitimate concern for advocates and consumers as well as policymakers and researchers.
State models need to be tested, comparative studies need to be conducted, and outcomes need to be assessed. But a debate over costs could paralyze further progress in developing a rational long-term care system in this country. Many vulnerable people will go without services if cost effectiveness is the only issue. Important lessons can be learned from the long-term care models that have already been developed. These models demonstrate a broad range of options that have been explored and implemented.