Human Resources

ADvancing States and the ARPA HCBS TA Collective Announce Release of Report Summarizing State Experiences with ARPA HCBS Initiatives

April 23, 2024
CONTACT: Camille Dobson

ARLINGTON, VA — ADvancing States and our partners in the American Rescue Plan Act (ARPA) home and community-based services (HCBS) Technical Assistance Collective (TA Collective) are proud to release a report sharing findings about states’ experience in implementing their ARPA HCBS initiatives. While the ARPA infusion of federal dollars into HCBS provided an historic opportunity to try bold, new approaches to supporting people in their homes and communities, states were challenged to make systemic improvements given the time-limited nature of the federal funds.

To gather insights into states’ experiences in implementing their ARPA HCBS spending plans, the TA Collective fielded a national survey in early 2024 that aimed to identify successful strategies used by states implementing their ARPA HCBS spending plans, as well as any barriers hindering their success. Based on responses to that survey, this report highlights the challenges and barriers states faced in thoughtfully executing their initiatives in the midst of a public health emergency. The thirty-three states that responded to the survey shared the top barriers to implementing their projects as planned. These barriers include:

  • Delays in obtaining approval from CMS for both their spending plans and the necessary federal authorities to implement those plans;
  • Lack of staff capacity to design and implement complex initiatives;
  • The time it takes to complete state procurement processes to implement projects; and
  • The need to secure legislative approval and/or budget authority before beginning work.

The report also suggests ways to make any future time-limited investments in the HCBS system more effective, including giving states more time to implement, easing the CMS approval process and providing resources to both states and CMS. Moreover, any future investments should be accompanied by a federal evaluation to glean insights into successful interventions that could be replicated across the country.

While this report highlights challenges and lessons learned, it should be noted that, against all odds, states created transformational change with their ARPA spending plan initiatives. Our hope is that this report — and the recommendations contained therein — serves as a roadmap for any future federal investment in the HCBS system.

This report is also informed by the TA Collective’s work supporting states with their ARPA initiative planning, implementation, and evaluation activities and by observations and analysis of state and federal ARPA HCBS activities. It builds upon the TA Collective’s past work including, Efforts to Evaluate the Impact of ARPA HCBS Investments, an issue brief examining state evaluation approaches, and a summary of the work of the HCBS Sustainability Summit, which provided valuable context on sustaining the HCBS commitment fostered by ARPA investments. Both reports can be found here.

We are grateful to The John A. Hartford Foundation, the Care for all with Respect and Equity (CARE) Fund, The SCAN Foundation, and the Milbank Memorial Fund for their support in making the work of the TA Collective possible.

Visit here to read the new report.

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Image by Gerd Altmann from Pixabay

RCPA’s 2024/25 membership year begins July 1, and this week marks the beginning of our membership renewal period. You can download the membership applications directly from the RCPA website on our Join/Renew page. Dues are owed by July 1, 2024.

Please contact Tieanna Lloyd at (717) 963-3609 or via email with any questions, and thank you for your continued support of the association. We look forward to working with you during the 2024/25 membership year!

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RCPA member Familylinks’s President and CEO Stacey Vaccaro is currently completing a study for her PhD regarding the characteristics of health and human services managers that make them stay in the industry. Members can assist Stacey by completing this questionnaire. The information obtained will help to shed light on whether or not some managers are truly “built” for this work. The questionnaire will take about 10 minutes to complete and will provide valuable insight to help us all better understand the managers in the industry.

Should you have questions, please contact Stacey directly about the study. You may also contact the faculty sponsor, Dr. J. Rosendale.

This project has been approved by the Indiana University of Pennsylvania Institutional Review Board for the Protection of Human Subjects (Phone 724-357-7730).

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Visualizing the Behavioral Health Workforce Crisis
February 22, 2024, 12:00 pm – 1:00 pm EST
Register Here
Featuring Charles Klinger, Chief Operating Officer, Behavioral Health Alliance of Rural PA (BHARP)

Charles has led a collaborative data project across 24 Pennsylvania counties. It paints a picture of a devastated workforce.

Agencies provide this data, and review it with government and managed care. It is being used to support recruitment and retention efforts.

Charles and his team are working together to find solutions to the BH workforce crisis.

Charles has led the Provider Workforce Staffing (PWS) report in response to the major changes in behavioral health staffing since 2020. Over 20% of available positions remain unfilled, signaling an increased divide between available workers and population need.

This report highlights the costs of adequately filling our network in a clear and comprehensive way. Average rate of pay for a multitude of mental health jobs have been reviewed in the PWS report, from psychiatrists to housekeepers.

Most BH staffing problems arise from lack of available workers. According to Charles’ research, workers are leaving jobs, and there are no candidates available to replace them. Many jobs have consistently remained vacant.

For those from Pennsylvania, the PWS is particularly illuminating, as it focuses on state-specific needs, like the loss of workers in every level from outpatient care, to intensive behavioral health services (IBHS).

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There is a request from an RCPA member who is looking to revise some policies and job descriptions for their organization. Please contact Fred Serino, Director of Human Resources at Vista Autism Services, if you are willing to share the following policies/job descriptions from your organization:

  • Inclement weather policy;
  • Evaluation form and process; and/or
  • Job description for Director of QA/QI.

In addition to this request, you can also view and share information, as well as post questions, on the RCPA website under the HR Forum. Please access the online forum under the Human Resources drop-down menu at the top of the RCPA website (note that you must be logged in with your RCPA member website account). If you do not have access, please request access here. Contact Sharon Militello if you have questions concerning the HR forum.

We thank you for your assistance with this request.