What is HCBS?
Home and Community-Based Services (HCBS) are an array of long-term services and supports delivered in a person’s home or community—rather than in an institutional setting—that enable older adults and people with disabilities to live, work, and participate in the most integrated setting consistent with their needs and preferences. These services include, but are not limited to, personal care and assistance with activities of daily living, home health, homemaker and chore services, respite for family caregivers, adult day services, case management, non-medical transportation, home-delivered meals, home modifications, and durable medical equipment.
Family Centered Care
In American Samoa, home is already where most long-term care takes place, and family members are the primary caregivers. In the Samoan way of life (Fa'a Sāmoa), the 'aiga is one; we care for our elders and loved ones because they are part of us. Yet caregiving also carries real costs: building a wheelchair ramp, obtaining training for a caregiver, or giving up income when someone steps away from work to provide care. Home-and community-based services (HCBS) are one way to strengthen these supports, working alongside families and within the resources available.
Why HCBS matters
HCBS, as defined above, is a territory-wide system of services supported by multiple funding sources. Medicaid is one of these sources and is population-specific: under federal law, it reimburses only Medicaid-eligible individuals for covered services delivered by enrolled providers. As a result, Medicaid dollars reach only the Medicaid-eligible share of the people served by HCBS. The federal Money Follows the Person (MFP) initiative strengthens this part of the system by supporting the transition of long-term care from institutional settings to home and community settings. Part of the Commission’s role is to examine how these components fit together and to offer recommendations to the Governor and the Medicaid State Agency for their consideration, so that the territory’s residents are served as fully as the available resources allow.