The Future of Home and Community-Based Services (HCBS): Innovation, Integration, and Uncertainty
At HCB Strategies, we believe the future of Home and Community-Based Services (HCBS) represents both the greatest opportunity and the greatest risk facing long-term services and supports in the United States. HCBS is not just a policy category—it is the foundation of independence and dignity for people with disabilities, individuals with behavioral health need and older adults.
As states, providers, and payers confront shifting demographics, federal Medicaid changes, and workforce crises, the future of HCBS will be determined by how well we innovate, integrate, and anticipate what lies ahead. Our role is to help leaders not only navigate this moment, but to drive transformation with confidence.
Rising Demand and Workforce Sustainability
The demand for HCBS is accelerating. An aging population and the expansion of community living options have created unprecedented pressure on states and providers. Yet the direct support workforce remains fragile. Low wages, high turnover, and limited pipelines jeopardize the stability of services.
At HCB Strategies, we know that without bold workforce investments, the system cannot meet rising demand. We help states and organizations design sustainable wage structures, build career pathways, and implement workforce strategies that balance policy, funding, and quality outcomes.
Technology as an Accelerator
Technology is rapidly reshaping HCBS. Telehealth, remote monitoring, and AI-driven tools are not futuristic—they are already transforming how care is coordinated and delivered.
The challenge is ensuring equitable adoption. Rural communities and underfunded providers risk falling behind. HCB Strategies works with states and provider networks to integrate digital platforms, deploy assistive technology, and leverage predictive analytics, ensuring innovation serves all communities, not just those with resources.
Integration with Health Care and Value-Based Models
The historic divide between HCBS and health care has led to inefficiencies, gaps, and poorer outcomes. As value-based models take hold, integration is no longer optional—it is essential.
HCB Strategies helps leaders design models that align HCBS providers, managed care organizations, and state systems around shared accountability. We build frameworks that reward outcomes, strengthen care coordination, and bridge silos across medical, behavioral health, and social supports.
Federal Medicaid Uncertainty
The most pressing uncertainty shaping the future of HCBS is the trajectory of federal Medicaid policy. Proposals for per-capita caps, block grants, and altered federal match rates have the potential to destabilize HCBS funding across the country. Even less dramatic shifts—such as tighter budget neutrality in 1115 waivers—could restrict state flexibility and force difficult trade-offs.
At HCB Strategies, we monitor federal trends daily and help states, associations, and providers prepare for multiple scenarios. Our strategies anticipate funding volatility, protect access to services, and position HCBS as a cost-effective alternative to institutional care.
Centering Equity and Choice
At its core, HCBS is about ensuring people have the opportunity to live, work, and participate fully in the community of their choice. That vision requires a sharper focus on equity. Persistent disparities in access and quality—particularly in rural areas and among communities of color—cannot be ignored.
HCB Strategies works with partners to embed equity into every aspect of service design. We help leaders expand self-direction, co-design programs with individuals who use them, and create systems that honor culture, language, and community context.
Our Role in Shaping the Future
As a trusted strategic partner, HCB Strategies supports leaders at every level—state agencies, provider organizations, associations, and health plans—by:
• Anticipating policy and funding shifts to minimize risk and ensure sustainability.
• Designing structures that support provider viability.
• Building workforce strategies that address recruitment, retention, and professional development.
• Guiding adaptation to value-based models with practical tools and accountability frameworks.
• Embedding equity and person-centered practices to ensure services reflect the voices of the people who rely on them.
We bring both the granular understanding of service delivery and the strategic perspective of system transformation—a dual lens that allows us to bridge policy with practice.
The future of HCBS will be shaped by both innovation and uncertainty. Technology, workforce development, and integration with health care create pathways to a stronger, more responsive system. But federal Medicaid changes present real risks that could erode hard-won progress if stakeholders are not prepared.
At HCB Strategies, we are relentless in helping our partners meet these challenges head-on. We believe HCBS must remain the cornerstone of long-term services and supports—anchored in dignity, equity, and independence. The responsibility before us is clear: to not only protect HCBS, but to strengthen it for generations to come.