Home & Community Based Services Health and Welfare

States are responsible for continuously and effectively assuring the health and welfare of participants in Home and Community Based Services (HCBS) programs. Under Section 1915(c) of the Social Security Act, HCBS waivers must provide assurances to the Centers for Medicare & Medicaid Services (CMS) that the state has necessary safeguards to protect the health and welfare of participants receiving services.

States must demonstrate they have an effective incident management system for assuring waiver participant health and welfare, and that they continually identify, address, and seek to prevent instances of abuse, neglect, exploitation, and unexplained death. CMS provides resources intended to assist states in addressing health and welfare concerns in their HCBS programs and design robust incident management systems that enable states to proactively respond to incidents and implement actions that reduce the risk of future incidents.

• CIB: Health and Welfare of Home and Community Based Services (HCBS) Waiver Recipients

In 2019 CMS began conducting state site visits in-person, virtual and hybrid (a combination of in-person and virtual) with a focus on the states’ implementation of health and welfare oversight of home and community-based programs.  The site visits also focus on preparing the states for waiver renewals, identifying promising practices and/or challenges, and providing technical assistance.

This table provides cover letters and accompanying summary reports issued at the conclusion of health and welfare site visits.  The table is updated as additional state site visits are completed.