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.

Recent Guidance

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

Authorities

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.

State Transition Plans

The final HCBS regulation published January 26, 2014, requires states operating a section 1915(c) waiver or a section 1915(i) state plan benefit (that was in effect on or before March 17, 2014) to submit a statewide transition plan addressing compliance with the regulation. More information about this plan is available in the Statewide Transition Plan Toolkit for Alignment with HCBS Settings Regulation Requirements.

In an effort to keep stakeholders apprised of the status of HCBS Statewide Transition Plans (STP), the following documents will be posted on the Statewide Transition Plans page, as they become available or are sent to states:

  1. Proposed Plan URL: The URL link to the STP the state submitted to CMS.
  2. CMIA: Clarifications and/or Modifications required for Initial Approval: The communication CMS sends to the state notifying the state that public comment, input and summary requirements are met, but CMS has identified issues that must be resolved in the STP prior to initial approval.
  3. Initial Approval with Milestones and a Resubmission Date: The communication CMS sends to the state notifying the state that public comment, input and summary requirements are met, the STP is sufficient, but systemic and/or site-specific assessments are not yet completed.  The response to the state will vary dependent on whether the state has or has not identified settings that are presumed to have institutional characteristics and any information the state may wish CMS to consider under the heightened scrutiny process.  
  4. Final Approval:  The communication CMS sends to the state notifying the state that public comment, input and summary requirements are met, the STP has provided all necessary information including but not limited to; systemic assessment, site specific assessment, settings presumed to have institutional characteristics, information regarding heightened scrutiny or the state‚Äôs decision to let the presumption stand, and clear remedial steps with milestones are delineated.  
  5. Approved Plan:  The CMS approved STP is posted on the Statewide Transition Plans page.