108 Iowa L. Rev. 379 (2022)

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Abstract

In Olmstead v. L.C., the Supreme Court held that individuals are entitled to receive skilled care in the least restrictive setting appropriate to their care needs. This was a major advancement for many older adults and individuals with disabilities living in institutional facilities but wishing to receive care in their home or community. In the years since the Olmstead decision, the use of home and community-based care (“HCBS”) has dramatically increased as an alternative to institutional care. However, a lack of available care providers has led to months- and years-long waiting lists for those in need of care who wish to receive HCBS care through their state Medicaid programs.

This Note argues that state Medicaid programs should allow spouses to be reimbursed as a Medicaid recipient’s HCBS care provider. This would increase the pool of available caretakers, while also alleviating the financial strain those informally taking care of a partner can face. Fifteen states currently allow spouses to be paid as caretakers through federal waivers of traditional Medicaid program requirements. This Note analyzes the key policy choices these states make to allow spouses to be paid caretakers while managing program fraud and abuse concerns—and argues that additional states should follow suit.