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.

Final Regulation: 1915(i) State Plan HCBS, 5-Year Period for Waivers, Provider Payment Reassignment, Setting Requirements for Community First Choice, and 1915(c) HCBS Waivers - CMS-2249-F/CMS-2296-F
- Informational Bulletin - Final regulations for HCBS provided under Medicaid’s 1915(c), 1915(i) and 1915(k) authorities
- Press Release - Final regulations for HCBS provided under Medicaid’s 1915(c), 1915(i) and 1915(k) authorities
- Fact Sheets Regarding Final Regulation CMS-2249-F/CMS-2296-F

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:

A summary of the regulatory requirements of fully compliant HCB settings and those settings that are excluded.
Schematic drawings of the heightened scrutiny process as a part of the regular waiver life cycle and the HCBS 1915(c) compliance flowchart.
Additional technical guidance on regulatory language regarding settings that isolate.
Exploratory questions that may assist states in the assessment of:
- Residential Settings
- Non-Residential Settings
Questions and Answers Regarding Home and Community-Based Settings
Statewide Transition Plan Toolkit for Alignment with HCB Settings Regulation Requirements Suggestions for alternative approaches and considerations for states as they prepare and submit Statewide Transition Plans for the new federal requirements for residential and non-residential home and community-based settings. The regulatory requirements can be found at 42 CFR 441.301(c)(4)(5) and 441.710(a)(1)(2).
HCBS Basic Element Review Tool for Statewide Transition Plans and HCBS Content Review Tool for Statewide Transition Plans

Additional Resources

Modifications to Quality Measures and Reporting in §1915(c) Home and Community-Based Waivers

State Medicaid Director’s Letter- August 2010 – Improving Access to Home and Community-Based Services

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.

Featured Resources:

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