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Home & Community Based Services


Home and community-based services (HCBS) provide opportunities for Medicaid beneficiaries to receive services in their own home or community. These programs serve a variety of targeted populations groups, such as people with mental illnesses, intellectual or developmental disabilities, and/or physical disabilities.


The final Home and Community-Based Services regulations set forth new requirements for several Medicaid authorities under which states may provide home and community-based long-term services and supports. The regulations enhance the quality of HCBS and provide additional protections to individuals that receive services under these Medicaid authorities.

 Settings Requirements Compliance Toolkit


CMCS is pleased to share with State Medicaid Agencies, Operating Agencies, and other stakeholders a Home and Community-Based Settings Toolkit to assist states develop Home and Community-Based 1915(c) waiver and 1915(i) SPA amendment or renewal application(s) to comply with new requirements in the recently published Home and Community Based Services' (HCBS) regulations.
The toolkit includes:

 Additional Resources


HCBS first became available in 1983 when Congress added section 1915(c) to the Social Security Act, giving States the option to receive a waiver of Medicaid rules governing institutional care. In 2005, HCBS became a formal Medicaid State plan option. Several States include HCBS services in their Medicaid State plans. 47 States and DC are operating at least one 1915(c) waiver.

State Medicaid agencies have several HCBS options:

CMS works with States to assure and improve quality in Medicaid HCBS waiver programs. See page on quality monitoring of HCBS waivers for more information

CMS has developed the following reports that highlight promising practices in home and community-based services offered by States to enable persons of any age who have a long-term illness or disability to live in the most integrated community setting appropriate to their individual support requirements and preferences.


Submission of Statewide Transition Plans

As part of the submission process, each state is required to provide the URL where stakeholders can access the Statewide Transition Plan that is submitted to CMS for review (reference:  Statewide Transition Plan Toolkit for Alignment with the Home and Community-Based Services (HCBS) Final Regulation’s Setting Requirements, September 5, 2014). When a Statewide Transition Plan is submitted, CMS will post that URL on Medicaid. gov.

Posting of Approved Statewide Transition Plans

Once CMS has completed its review and approval of each Statewide Transition Plan, the plan will be posted on Medicaid. gov.

State URLs













New Hampshire  

North Dakota  


South Dakota  




West Virginia  



Featured Resources:


Information provided by the Disabled and Elderly Health Programs Group. To request clarifications please contact hcbs@cms.hhs.gov.