Investments in home and community-based services could save Florida $745 million a year, report finds


Nicole Pasia


Florida has one of the highest percentages of residents over age 65 in the nation, pushing the continuum of care for seniors to the forefront of health care discussions. Currently, much of Florida’s health care spending for seniors is through institutionalized care, according to a recently released report from Florida TaxWatch, an independent research institute. 

The report, titled “Aging in Place: The Economic and Fiscal Value of Home and Community-Based Services,” (HCBS) found that shifting costs to providing in-home care rather than in a nursing home could save the state over $745 million before adjusting for inflation. 


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Image: Aging in Place—The Economic and Fiscal Value of Home and Community-Based Services, Florida TaxWatch


Aside from fiscal savings, investments in HCBS could lead to increased physical safety for seniors. During the Delta variant surge last summer, COVID-19 infection rates among Florida nursing home staff topped the nation and put residents at risk. 

Infection and death rates in HCBS residents were significantly lower. The report cited the Journal of Post-Acute and Long-Term Care Medicine (JAMDA), which found that from March-July 2020, 37% of nursing home residents and 14% of assisted-living facility residents nationwide contracted COVID-19, compared to 2% of HCBS residents. Eleven percent of nursing home residents and 5% of assisted-living facility residents died from COVID-19, compared to 1% of HCBS residents. 

Investing in HCBS can also lead to improved quality of life and care for seniors. A 2017 study from the U.S. The Department of Health and Human Services found that people who transitioned from institutionalized care to HCBS reported higher levels of satisfaction with their care and higher life satisfaction within two years. Similarly, they reported lower levels of depressive symptoms and unmet need for personal care within the same period. 


Image: Aging in Place—The Economic and Fiscal Value of Home and Community-Based Services, Florida TaxWatch


“We need a better investment strategy to ensure that seniors have the best long-term care HCBS options available throughout their aging journey,” AARP Florida State Director Jeff Johnson said in a statement on the report. “The fundamental outcomes of this analysis show that investment in these programs would benefit millions of Florida families and caregivers who are providing uncompensated medical and personal care to loved ones.”

Florida TaxWatch offered a number of policy recommendations that would maximize investment in HCBS. These included establishing standard quality metrics for HCBS services. The report mentions the National Core Indicators for Aging and Disabilities (NCI – AD) as a possible avenue to use for the quality metrics, a program in which Florida is yet to join. 

The report also drew attention to the potential for using federal funds to support HCBS—one area where Florida has made some progress. In July 2021, the Agency for Health Care Administration (AHCA) submitted a $1.1 billion spending plan to the Centers for Medicare and Medicaid Services (CMS). 

The plan would use increased Federal Medical Assistance Percentages (FMAP) from the American Rescue Plan Act (ARPA) over three years to fund provider payments and reduce waitlists for HCBS programs.  

CMS approved the spending plan in late December 2021, and AHCA has opened applications for providers to apply for the funding. Applications are due in February 2022, and additional applications for other forms of HCBS support under the spending plan are expected in April 2022.