GAO Finds State Coordination Gaps in VR and Medicaid HCBS Employment Services
In a September 2026 report, GAO examined how vocational rehabilitation (VR) and Medicaid home- and community-based services (HCBS) programs fund employment services for individuals with intellectual or developmental disabilities in Georgia, Pennsylvania, and Washington. Employment service providers reported administrative burden and service gaps when navigating two separate state agencies, including confusion over when VR closures must occur before Medicaid HCBS employment services can begin. States typically fund services sequentially — VR first, then Medicaid HCBS — rather than braiding multiple funding streams simultaneously. Federal agencies issued joint guidance in 2022 encouraging coordination strategies, but provider-reported challenges persist.