HSE 330 Milestone Three: Submit A Paper That Covers The Grou ✓ Solved

HSE 330 Milestone Three: Submit a paper that covers the grou

HSE 330 Milestone Three: Submit a paper that covers the groups, individuals, and organizations that support the legislation you have selected for your final project, as well as those that oppose it, and why. IV. Stakeholders and Coalition Building. This section should cover which groups, individuals, and organizations support this legislation, which oppose it, and why. Specifically address: a. Who should be responsible for developing, implementing, and paying for the changes you propose? Why? Take into consideration the policy development process for human services legislation and different groups’ resources. b. Have the intended beneficiaries taken a position on the legislation being considered? If not, why not? If so, what is their position and how have they communicated it? Support your answer. c. What other groups, organizations, or individuals have an interest in the legislation? Do they support or oppose it and why? Provide evidence. d. What strategies would you recommend in building support for the changes you suggest? Identify potential allies and activities they might undertake to influence the policy process, considering different levels of advocacy (community, national advocacy groups, business, media, global activism).

Paper For Above Instructions

Introduction: Selected Legislation

The selected legislation for this analysis is a state-level policy to expand Medicaid Home and Community-Based Services (HCBS) by increasing reimbursement rates, funding workforce development, and shifting a portion of Medicaid long-term services and supports (LTSS) funding from institutional care to community-based alternatives. The rationale is to improve access, quality, and equity for older adults and people with disabilities who prefer services in home and community settings (Kaiser Family Foundation, 2021; Centers for Medicare & Medicaid Services [CMS], 2020).

Stakeholders and Roles

a. Responsibility for Development, Implementation, and Payment

Development: State Medicaid agencies, in partnership with advocacy groups, provider associations, and legislative sponsors, should lead policy development because they understand existing program structures and can design feasible waiver amendments or state plan options (Urban Institute, 2017). Federal partners (CMS) play a regulatory and approval role for Medicaid waivers and funding mechanisms (CMS, 2020).

Implementation: Implementation responsibilities should be shared among state health/aging departments, managed care organizations (where applicable), and provider networks (home care agencies, community-based organizations). States are best positioned to operationalize eligibility, provider credentialing, and quality-monitoring frameworks; providers deliver services on the ground and must be integrated into implementation planning (KFF, 2021).

Payment: Funding should be a combination of federal Medicaid matching funds and state fiscal contributions, supplemented by targeted state investments (e.g., workforce grants) and philanthropic seed funding to pilot innovative models. This shared financing approach reflects the federal-state nature of Medicaid and distributes costs according to fiscal capacity and political feasibility (Urban Institute, 2017; Families USA, 2022).

Rationale Considering Policy Process and Resources

State agencies possess statutory authority and administrative capacity to implement changes, while federal matching funds incentivize state action. Provider associations and labor groups can help channel resources into the workforce, but states will ultimately bear operational complexity and political risk; therefore, buy-in from governors and legislative leaders is essential (Commonwealth Fund, 2018).

Beneficiaries’ Positions

The intended beneficiaries—older adults, people with disabilities, and family caregivers—have generally supported HCBS expansion. National organizations representing beneficiaries, such as AARP and disability rights groups, have publicly advocated for increased HCBS funding, citing improved quality of life and cost-effectiveness compared with institutional care (AARP Public Policy Institute, 2019; National Council on Aging, 2020). Beneficiary advocacy has been communicated through public comments to state Medicaid agencies, testimony at legislative hearings, grassroots petitions, and coalition-led media campaigns (AARP, 2019).

However, some subgroups remain less organized and thus less vocal—people with complex medical needs or those in rural areas may lack representation because of service fragmentation and limited advocacy infrastructure (KFF, 2021).

Other Interested Groups and Their Positions

Supporters:

• Advocacy organizations (AARP, disability rights groups) support HCBS for autonomy and cost-saving potential (AARP, 2019; National Council on Aging, 2020).
• Home and community-based provider associations generally support expansion because it increases service demand and can improve reimbursement (KFF, 2021).
• Labor unions representing direct care workers support increased reimbursement tied to wage and benefit improvements (Families USA, 2022).

Opponents or Skeptical Parties:

• Nursing home industry groups may oppose rapid fund-shifting due to revenue loss and potential bed occupancy declines (Commonwealth Fund, 2018).
• Fiscal conservatives or budget hawks may resist increased state spending without clear short-term offsets, arguing for targeted pilots rather than large-scale expansion (Urban Institute, 2017).
• Some managed care organizations may be cautious if payment reforms increase administrative burden (CMS, 2020).

Evidence of these positions appears in public comment records, industry trade publications, and policy briefs from advocacy coalitions (KFF, 2021; Commonwealth Fund, 2018).

Strategies for Building Support and Coalition Building

1. Build a Broad, Credible Coalition

Assemble a coalition including beneficiary organizations (AARP, disability groups), provider associations, labor unions, faith-based groups, and fiscally-oriented policy analysts. Cross-sector coalitions increase legitimacy and ensure multiple narratives—human dignity, workforce stability, and cost-effectiveness—are advanced simultaneously (Families USA, 2022).

2. Use Data-Driven Messaging

Highlight rigorous evidence about HCBS outcomes and cost implications (KFF, 2021; Urban Institute, 2017). Translate state-specific data showing potential Medicaid savings, reduced hospital readmissions, and preferred beneficiary settings to persuade budget-conscious policymakers.

3. Targeted Advocacy Tactics

- Grassroots mobilization: empower beneficiaries and caregivers to testify, meet with legislators, and share stories (AARP, 2019).- Legislative briefings: present fiscal models and phased implementation plans to legislative budget committees (Urban Institute, 2017).- Media and earned publicity: coordinate op-eds, local TV spots, and social media campaigns featuring beneficiary stories and provider perspectives (Commonwealth Fund, 2018).- Strategic pilots: propose pilot projects to demonstrate feasibility and refine payment models before full-scale rollout (CMS, 2020).

4. Engage Potential Opponents Constructively

Negotiate transition assistance for institutional providers, e.g., incentives to develop community-based programs or participate in managed transitions. This can reduce opposition from nursing home groups and align interests toward diversified service portfolios (Commonwealth Fund, 2018).

5. Leverage Multi-Level Advocacy

Coordinate local organizing with national advocacy organizations to sustain pressure across policymaking levels. Use business and employer coalitions to underscore workforce and caregiver productivity benefits, appealing to economic stakeholders (Families USA, 2022).

Conclusion

Expanding Medicaid HCBS requires a coordinated approach that assigns development and implementation responsibilities to state agencies and providers, shares costs between federal and state governments, and leverages a broad coalition of advocates. Beneficiary organizations largely support HCBS expansion and have communicated through testimony and advocacy; other stakeholders vary in position based on financial and operational interests. A multi-pronged advocacy strategy—grounded in data, inclusive coalitions, targeted pilots, and constructive engagement with potential opponents—offers the best pathway to build durable support for the legislation.

References

• AARP Public Policy Institute. (2019). Valuing the caregiving workforce: Issues and policy options. AARP.
• Centers for Medicare & Medicaid Services. (2020). Home & Community-Based Services (HCBS) overview. U.S. Department of Health and Human Services.
• Commonwealth Fund. (2018). Shifting long-term services and supports to home and community-based settings: Policy options and challenges.
• Families USA. (2022). Medicaid and home- and community-based services: Improving access and quality.
• Kaiser Family Foundation. (2021). Medicaid’s role in home and community-based services: Trends and policy considerations.
• National Council on Aging. (2020). Advocacy toolkit: Ensuring access to home and community-based services.
• National Association of Social Workers. (2018). Position statement: Long-term care and community-based supports.
• Urban Institute. (2017). Financing long-term services and supports: Federal and state options.
• American Public Health Association. (2016). Policy statement: Expanding access to home and community-based services.
• Centers for Disease Control and Prevention. (2013). The state of aging and health in America: Key indicators and implications for long-term services and supports.