Opinion: Connecticut should continue to fund home and community-based services

Hartford Courant – Tuesday, October 14, 2025
By Dr. Annie Yang

Annie Yang, MD is a physician-fellow at the National Clinician Scholars Program at Yale School of Medicine and the West Haven VA Medical Center. She is also affiliated with Hartford Hospital as a hospitalist.

Earlier this year, I cared for a gentleman in the hospital who was nearly 70 years old and had been admitted for almost two months. After losing his job last year, he had fallen back on alcohol, and things spiraled from there. He lived alone, was not receiving proper nutrition, and among a multitude of medical issues, he was clearly malnourished. But after proper treatment, he regained weight and strength and was motivated to maintain his health. The hospital team worked on applying for Medicaid to arrange a safe setup for discharge, somewhere he could live independently but still receive assistance with household chores, transportation, and meal preparation. This was now the primary reason he remained in the hospital.

This gentleman was a perfect candidate to receive Medicaid-covered home and community based services (HCBS), a set of services that could be on the chopping block in the wake of significant federal cuts to Medicaid. Estimates project more than $11 billion could be cut from Connecticut’s Medicaid program over the next 10 years. State legislators may convene a special session before the end of the year, perhaps even as early as October, where a likely talking point will be preparing for large federal cuts.

Medicaid serves as the primary payor for various HCBS waiver programs, which cover supports such as adult day care, home delivered meals, respite care for informal caregivers, and transportation. These services have been critical for more than 17,000 Connecticut residents per month who are older or have disabilities. Those who would need nursing home-level care can instead apply for HCBS, such as the Connecticut Home Care Program for Elders, which helps them continue to reside at home. Some could even consider applying for Assisted Living, a setting I believe my patient would thrive in.

If we do not protect HCBS, I am concerned about the irreversible downstream health repercussions for patients and increased demand on hospitals. With reduced access to services, patients are at risk of becoming more frail, experiencing significant loss of function, or suffering acute illnesses, all of which will inevitably lead to more frequent and costly hospitalizations. Each hospital admission and emergency room visit will cost significantly more than caring for these patients at home. Moreover, between 2019 and 2023, expenditures for hospital services among Medicaid beneficiaries have already grown considerably by 24%, and increased demand for hospital care would only strain the state’s budget as well hospitals’ capacity.

HCBS are required to cost less than the amount it would take to pay for nursing home care. On average, nursing home care can cost 3 times more than caring for a participant in the Connecticut Home Care Program for Elders. Without HCBS individuals who need them are more likely to be admitted to nursing homes – and faster too. For these reasons HCBS do not just serve the health and safety of Connecticut residents but are also a financially responsible investment.

To be sure, the state is wrestling with financial uncertainty and competing responsibilities, such as the potential loss of coverage through Connecticut’s health insurance exchange. But protecting the health of Connecticut residents who are older or have disabilities cannot be overlooked or delayed.

So whenever our legislators do hold a special session and choose to discuss the implications of forecasted Medicaid cuts, I urge them to (1) protect Medicaid and state-funded HCBS, such as the Connecticut Home Care Program for Elders, and (2) continue to explore existing demonstrations and pilots, such as the Assisted Living Facility demonstration. Although some of the cuts may not take effect until later in 2026, it is by no means too early to plan for continued investment in the long-term health of Connecticut’s residents.

You don’t have to hear it from me: this responsibility has been codified into our state’s own statute since 2005 under Public Act 05-14, where Connecticut avowed to ensure “individuals with long-term care needs have the option to choose and receive long-term care and support in the least restrictive, appropriate setting.” We must continue to uphold this commitment.

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