Background
The COVID-19 public health emergency (PHE) has underscored the urgent need to reduce the reliance on institutional services and expand access to high-quality home and community-based services (HCBS) to improve outcomes for people with long-term services and supports (LTSS) needs. HCBS allow millions of Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings.
Consistent with many beneficiaries’ preferences for where they would like to receive their care, HCBS have become a critical component of the Medicaid program and of broader efforts across the federal government to promote community integration of older adults and individuals with disabilities. As the primary funder of HCBS nationally, Medicaid plays a critical role in supporting states’ efforts to strengthen these services for their beneficiaries. In November 2020, CMS released a toolkit (PDF, 1.27 MB) to help states to rebalance their LTSS systems by increasing the share of spending and service use delivered through HCBS, relative to spending and services provided through institutional care.
On March 11, 2021, President Biden signed the American Rescue Plan Act of 2021 (ARP) (Pub. L. 117-2). Section 9817 of the ARP provides qualifying states with a temporary 10 percentage point increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures for HCBS beginning April 1, 2021, and ending March 31, 2022. This increased funding, an estimated $12.7 billion, represents a rare opportunity for states to identify and implement changes aimed at addressing existing HCBS workforce and structural issues, expand the capacity of critical services, and begin to meet the needs of people on HCBS waitlists and family caregivers. This funding also provides states an important opportunity to enhance individual autonomy and community integration in accordance with the home and community-based settings regulation, Olmstead implementation, and other rebalancing efforts.
Use of the Funds to Enhance, Expand, or Strengthen HCBS
CMS recognizes the significant value of these additional funds, and is committed to working with our state partners to realize these improvements in the HCBS system, both in response to the COVID-19 PHE and in response to longstanding reform priorities. While states have broad flexibility in the use of the funds, CMS strongly encourages states to use the funds to implement structural changes to:
• Expand eligibility and increase access to HCBS for all Medicaid beneficiaries including those on waiting lists for HCBS waiver programs, children with disabilities, and people with behavioral health conditions;
• Offer a broader range of community-based services, particularly for people with behavioral health conditions;
• Make long term investment in HCBS infrastructure, including capital investments to expand access to non-disability specific settings as part of a state’s implementation of the home and community-based settings regulation;
• Support compliance with the home and community-based settings regulatory criteria and promote community integration;
• Strengthen the direct service workforce, including by increasing the pay and benefits of direct support professionals; and
• Address social determinants of health and improve equity for older adults and people with disabilities.
* In addition to demonstrating enhancing, enhancing, or strengthening HCBS, any use of the funds for capital investments must result in settings that are fully compliant with the home and community-based settings criteria.
State Activities Under ARP Section 9817
All 50 states and the District of Columbia have been fully approved to claim the HCBS FMAP increase April 1, 2021, until March 31, 2022, and to begin implementing activities in their spending plans and narratives.
States have included a number of innovative and exciting activities in their spending plans and narratives. For example, states are:
• Providing recruitment and retention bonuses, pay increases, and student loan forgiveness for direct support professionals, including behavioral health providers, as well as developing certification and training programs for direct support professionals (Nearly all state spending pans and narratives include workforce development initiatives);
• Expanding coverage of HCBS services to those who are currently on wait lists;
• Implementing in-home and mobile COVID-19 vaccination programs for people with disabilities and older adults;
• Developing deed-restricted accessible and affordable housing units for people with disabilities;
• Expanding access to assistive technologies to promote independence and community integration;
• Expanding HCBS eligibility to children with disabilities in the TEFRA group (commonly referred to as the Katie Beckett waiver);
• Implementing new behavioral health crisis response services for people with intellectual and developmental disabilities;
• Providing additional home-based services to support people to return home and avoid a skilled nursing facility admission following a hospitalization;
• Building partnerships to increase access to affordable and accessible housing and housing assistance for people with disabilities and older adults;
• Providing housing-related services and supports, such as home accessibility modifications and case management and other supportive services to help people obtain and maintain housing; and
• Developing new initiatives to increase access to competitive integrated employment for people with disabilities.
Recently Announced Changes
On June 3, 2022, CMS announced that it will not require states to demonstrate compliance with the March 31, 2024, deadline to fully expend the additional funding they received. States originally had a three-year period—from April 1, 2021, through March 31, 2024—to use the additional funding. Instead, CMS expects states to expend the funds by March 31, 2025. The extended timeframe of an additional year will help to facilitate high quality, cost-effective, person-centered services for people with Medicaid to remain in the setting of their choice, whether it is their home or another setting, and remain a valued part of their communities. CMS also announced that it has updated states’ reporting requirements to reduce state reporting burden while ensuring that CMS continues to receive timely and up to date information on state spending under ARP section 9817. See CMS’s State Medicaid Director letter (PDF, 255.41 KB) announcing these changes for more information.
Additional Information
For more information, contact HCBSincreasedFMAP@cms.hhs.gov.
American Rescue Plan Act of 2021 Section 9817 State Spending Plans and Narratives (as of federal fiscal year quarter 2)
To be eligible for additional federal funding under American Rescue Plan Act of 2021 (ARP) section 9817, participating states must submit a quarterly HCBS spending plan to provide information on the amount of funds attributable to the increase in FMAP that the state is claiming. States must also report on the cost of the activities they are implementing to enhance, expand, or strengthen HCBS. In addition, every other quarter, states must provide an updated spending plan narrative describing the state’s activities to enhance, expand, or strengthen HCBS.
This page provides:
- Each state’s spending plan and narrative;
- Letters that CMS has issued in response to the state’s spending plan and narrative.
State |
Spending Plan |
CMS Letters to States |
---|
AK
|
07/12/2021
10/28/2021 (rev)
 AK eFMAP Spending Plan Chart (PDF, 186.34 KB)
AK Adjusting ARP eFMAP Spending Plan (XLSX, 34.64 KB)
|
 AK ARP 98 17 Partial 09-23-202 (PDF, 265.16 KB)
 AK Q2 FY2022 Conditional Approval (PDF, 292.16 KB)
|
AL
|
07/12/2021
11/02/2021 (rev)
 AL State Spending Plan Quarterly Repo (PDF, 149.21 KB)
|
 AL ARP 9817 Partial 08-19-21 (PDF, 194.26 KB)
 AL Q2 FY2022 Conditional Approval 01-24-2022 (PDF, 264.56 KB)
|
AR
|
07/12/2021
 HCBS Spending Plan Draft_DMS (9.1) (PDF, 340.79 KB)
 HCBS Spending Plan Draft Arkansas (PDF, 246.04 KB)
|
 AR ARP 9817 RAI 08-27-21 (PDF, 275.76 KB)
 AR ARP 9817 Conditional 09-30-21 (PDF, 197.18 KB)
|
AZ
|
07/12/2021
11/01/2021 (rev)
 AZ ARPA HCBS Spending Plan (PDF, 2.58 MB)
|
 AZ ARP 9817 Partial 09-28-21 (PDF, 247.85 KB)
 AZ FY2022 Conditional Approval (PDF, 263.08 KB)
|
CA
|
07/12/2021
09/17/2021 (rev)
10/29/2021 (rev)
 CA HCBS Spending Plan Quarterly Repo (PDF, 1.15 MB)
|
 CA ARP 9817 Partial 09-03-21 (PDF, 406.13 KB)
 CA Q2 FY 2022 Conditional Approval (PDF, 280.05 KB)
|
CO
|
06/13/2021
11/16/2021 (rev)
 CO APRA Spending Plan Quarterly Repo (PDF, 375.72 KB)
|
 CO ARP 9817 Partial 07-23-21 (PDF, 340.85 KB)
 CO ARP 9817 Addendum 08-02-21 (PDF, 159.13 KB)
 CO ARP 9817 Conditional 09-21-21 (PDF, 303.28 KB)
 CO Q2 FY 2022 Conditional Approval 01-24-2022 (PDF, 287.54 KB)
|
CT
|
07/12/2021
11/03/2021 (rev)
 CT 9817 Spending Plan (PDF, 965.5 KB)
|
 CT ARP 9817 Partial 08-30-21 (PDF, 326.58 KB)
 CT Q2 FY 2022 Conditional Approval Letter (PDF, 254.87 KB)
|
DC
|
07/12/2021
11/01/2021 (rev)
 DC ARPA November 21 Quarterly Narrative (PDF, 385.5 KB)
|
 DC ARP 9817 Partial 08-31-21 (PDF, 211.44 KB)
 DC Q2 FY 2022 Partial (PDF, 293.93 KB)
|
DE
|
07/12/2021
10/26/2021
11/01/2021 (rev)
 DE Quarterly Update HCBS Spending Plan (PDF, 373.79 KB)
|
 DE ARP 9817 RAI 08-24-21 (PDF, 273.59 KB)
 DE ARP 9817 RAI 08-24-21 (PDF, 286.72 KB)
 DE Q2 FY2022 Partial Approval (PDF, 269.08 KB)
|
FL
|
07/12/2021
09/23/2021 (rev)
10/15/2021 (rev)
 FL FY 2022 Q2 ARPA HCBS Quarterly Repo (PDF, 230.71 KB)
|
 FL ARP 9817 RAI 08-11-21 (PDF, 296.65 KB)
 FL ARP 9817 Conditional 09-27-21 (PDF, 247.75 KB)
 FL Q2 FY 2022 Conditional Approval (PDF, 292.61 KB)
|
GA
|
07/12/2021
11/01/2021 (rev)
 GA ARPA Quarterly HCBD Spending Plan (PDF, 117.64 KB)
|
 GA ARP 987 Partial 09-13-21 (PDF, 389.82 KB)
 GA Q2 FY 2022 Conditional Approval (PDF, 264.69 KB)
|
HI
|
07/12/2021
 HI Spending Implementation (PDF, 1.38 MB)
|
 HI ARP 9817 Partial 09-14-21 (PDF, 316.83 KB)
 HI Q2 FY 2022 Partial Approval (PDF, 294.56 KB)
|
IA
|
07/12/2021
10/12/2021 (rev)
 IA Medicaid ARPA HBCS Spending Plan and Narrative (PDF, 419.38 KB)
|
 IA ARP Partial 09-13-21 (PDF, 267.95 KB)
 IA Q2 FY 2022 Conditional Approval (PDF, 263.39 KB)
|
ID
|
06/14/2021
10/13/2021 (rev)
 ID 9817 Amended Spending Plan (PDF, 332.94 KB)
 ID 9817 Quarterly Spending Plan (PDF, 162.75 KB)
|
 ID ARP 9817 Conditional 07-23-21 (PDF, 351.12 KB)
 ID ARP 9817 Addendum 08-02-21 (PDF, 161.42 KB)
 ID Q2 FY2022 Conditional Approval (PDF, 263.6 KB)
|
IL
|
07/12/2021
11/01/2021 (rev)
 IL 11-01-2021 ARP HCBS Quarterly Spending Narrative (PDF, 559.05 KB)
|
 IL ARP 9817 Partial 09-29-21 (PDF, 276.39 KB)
 IL FY22 Q2 Conditional Approval (PDF, 263.59 KB)
|
IN
|
07/09/2021
10/18/2021 (rev)
 IN HCBS Spending Plan First Quarterly (PDF, 832.42 KB)
|
 IN ARP 9817 Partial 09-30-21 (PDF, 383.41 KB)
 IN Q2 FY2022 Partial Approval (PDF, 268.4 KB)
|
KS
|
07/09/2021
10/05/2021 (rev)
 KS Revised HCBS 10% FMAP Enhancement Project Spending Plan (PDF, 138.44 KB)
 KS Revised Executive Summary (PDF, 768.97 KB)
 KS ARPA Section 9817 Initial Spending Plan (PDF, 171.1 KB)
|
 KS ARP 9817 Partial 09-30-21 (PDF, 226.74 KB)
 KS Q2 FY2022 9817 Conditional Approval (PDF, 262.71 KB)
|
KY
|
07/12/2021
11/01/2021 (rev)
 KY Enhanced FMAP Quarterly Update (PDF, 1.19 MB)
|
 KY ARP 9817 09-30-21 (PDF, 238.02 KB)
 KY FY 2022 Q2 Conditional Approval (PDF, 267.34 KB)
|
LA
|
07/12/2021
 LA HCBS Cover Letter (PDF, 297.52 KB)
|
 LA ARP 9817 Partial 08-17-21 (PDF, 227.31 KB)
 LA Q2 FY 2022 Partial Approval (PDF, 269.42 KB)
|
MA
|
06/17/2021
10/15/2021 (rev)
 MA APRA HCBS Quarterly Spending Plan Update (PDF, 996.06 KB)
|
 MA ARP 9817 Partial 07-23-21 (PDF, 393.67 KB)
 MA ARP 9817 Addendum 08-02-21 (PDF, 168.21 KB)
 MA Q2 FY 2022 Partial Approval (PDF, 304.16 KB)
|
MD
|
07/13/2021
11/01/2021 (rev)
 MD Quarterly HCBS Spending Plan (PDF, 269.54 KB)
|
 MD ARP 9817 Partial 09-28-21 (PDF, 257.08 KB)
 MD FY2022 Q2 Conditional Approval (PDF, 261.62 KB)
|
ME
|
07/09/2021
11/01/2021 (rev)
 ME Quarterly Report to CMS - HCBS FMAP Increase Plan (PDF, 365.79 KB)
|
 ME ARP 9817 Partial 09-20-21 (PDF, 267.68 KB)
 ME ARP 9817 Conditional 11-23-21 (PDF, 162.66 KB)
 ME Q2 FY2022 Conditional Approval (PDF, 262.28 KB)
|
MI
|
07/12/2021
 MDHHS HCBS Spending Plan Final (PDF, 277.06 KB)
|
 MI ARP 9817 Partial 09-30-21 (PDF, 259.07 KB)
|
MN
|
07/12/2021
08/11/2021 (rev)
11/02/2021 (rev)
 MN HCBS Spending Plan Quarterly Repo (PDF, 326 KB)
|
 MN ARP 9817 Partial 09-22-2021 (PDF, 437.57 KB)
 MN FY 22 Q2 Conditional Approval (PDF, 173.02 KB)
|
MO
|
07/12/2021
10/13/2021 (rev)
 MO Quarterly Spending Plan Q2-22 (PDF, 201.57 KB)
|
 MO ARP 9817 Partial 08-13-21 (PDF, 374.44 KB)
 MO Q2 FY 2022 9817 Partial Approval (PDF, 211.24 KB)
|
MS
|
07/12/2021
10/27/2021 (rev)
 MS ARPA HCBS Spending Plan (PDF, 297.14 KB)
|
 MS ARP 9817 Partial 09-30-21 (PDF, 300.75 KB)
 MS Q2 2022 9817 Conditional Approval (PDF, 264 KB)
|
MT
|
07/12/2021
09/28/2021 (rev)
 Montana HCBS Spending Narrative (PDF, 449.66 KB)
|
 MT ARP 9817 RAI 08-11-21 (PDF, 288.36 KB)
 MT ARP 9817 Conditional 09-30-2021 (PDF, 244.44 KB)
 MT Q2 FY 2022 Conditional Approval (PDF, 288.96 KB)
|
NC
|
07/12/2021
11/01/2021 (rev)
 NC Q2 ARP 9817 Spending Plan (002) (PDF, 345.67 KB)
|
 NC ARP 9817 Partial 09-24-21 (PDF, 294.56 KB)
 NC Q2 FY 2022 ARP Partial Approval (PDF, 297.94 KB)
|
ND
|
06/11/2021
 ND State Spending Plan for Implementation (PDF, 777.56 KB)
|
 ND ARP 9817 Partial 07-23-21 (PDF, 334.33 KB)
 ND ARP 9817 Addendum 08-02-21 (PDF, 158.58 KB)
|
NE
|
07/12/2021
10/15/2021 (rev)
 NE FY22 Q2 HCBS Spending Plan (PDF, 756.92 KB)
|
 NE ARP 9817 Partial 09-30-21 (PDF, 354.3 KB)
 NE Q2 FY2022 Conditional Approval (PDF, 264.62 KB)
|
NH
|
07/09/2021
 NH HCBS Final (PDF, 3.66 MB)
|
 NH ARP 9817 Partial 09-29-21 (PDF, 221.73 KB)
 NH FY 2022 Q2 Conditional Approval (PDF, 265.8 KB)
|
NJ
|
07/12/2021
 New Jersey HCBS FMAP Increase Spending Plan (PDF, 400.73 KB)
|
 NJ ARP 9817 Partial 09-29-21 (PDF, 221.54 KB)
 NJ 2022 Q2 Conditional Approval (PDF, 264.62 KB)
|
NM
|
07/12/2021
10/16/2021
 NM HCBS Spend Plan Cover Letter (PDF, 195.72 KB)
 NM HCBS Spending Plan with RAI Response (PDF, 617.71 KB)
 NM HCBS Spending Plan Exhibit A (PDF, 215.27 KB)
 NM HCBS Spending Plan Exhibit B (PDF, 206.99 KB)
|
 NM ARP 9817 RAI 09-27-21 (PDF, 287.29 KB)
 NM ARP 9817 Partial 11-05-21 (PDF, 288.88 KB)
|
NV
|
07/13/2021
 Nevada Initial Spending Plan (PDF, 757.19 KB)
|
 NV ARP 9817 Partial 09-30-21 (PDF, 365.99 KB)
 NV Q2 FY 2022 Conditional Approval Letter (PDF, 264.79 KB)
|
NY
|
07/08/2021
10/18/2021 (rev)
 NY Partial Approval Response ARPA HCBS FMAP (PDF, 253.09 KB)
|
 NY ARP 9817 Partial 08-25-21 (PDF, 313.29 KB)
 NY 2022 Q2 9817 Partial Approval (PDF, 270.16 KB)
|
OH
|
07/12/2021
10/19/2021 (rev)
 OH Q2 FY22 ARP Spending Plan (PDF, 621.65 KB)
|
 OH ARP 9817 RAI 09-28-21 (PDF, 266.39 KB)
 OH Q2 FY 2022 Partial Approval 12-13-21 (PDF, 302.18 KB)
|
OK
|
07/15/2021
 OK ARP Initial Spending Plan 07-15-21 (PDF, 1 MB)
|
 OK ARP 9817 Partial 09-15-21 (PDF, 217.74 KB)
 OK Q2 FY 2022 Conditional Approval (PDF, 263.89 KB)
|
OR
|
06/11/2021
 OR OHA Letterhead (PDF, 179.39 KB)
 OHA-ODHS HCBS Enhanced Funding (PDF, 139.12 KB)
|
 OR ARP 9817 RAI 07-23-21 (PDF, 284.92 KB)
 OR ARP 9817 Addendum 08-02-21 (PDF, 165.89 KB)
 OR ARP 9817 Partial 09-30-21 (PDF, 344.74 KB)
|
PA
|
06/14/2021
11/15/2021 (rev)
 PA DHS Quarterly Rev II Aug 2021 (PDF, 590.63 KB)
|
 PA ARP 9817 Partial 07-23-21 (PDF, 353.2 KB) (PNG, 113.75 KB)
 PA ARP 9817 Addendum 08-02-21 (PDF, 160.75 KB)
 PA ARP 9817 Conditional Approval 12-01-2021 (PDF, 256 KB)
|
RI
|
07/09/2021
 RI Spending Plan ARPA HCBS (PDF, 797.84 KB)
|
 RI ARP 9817 Partial 08-09-21 (PDF, 186.7 KB)
 RI Q2 FY 2022 Partial Approval (PDF, 274.58 KB)
|
SC
|
07/12/2021
10/19/2021 (rev)
 SC Quarterly Spending Plan Oct. 21 (PDF, 360.96 KB)
|
 SC ARP 9817 Partial 08-11-21 (PDF, 183.64 KB)
 SC Q2 FY2022 Conditional Approval (PDF, 266.74 KB)
|
SD
|
07/27/2021
 10 Percent HCBS Spending Plan 07-27-21 (PDF, 269.68 KB)
|
 SD ARP 9817 Partial 09-27-21 (PDF, 327.22 KB)
 SD Q2 FY 2022 Conditional Approval Letter (PDF, 264.68 KB)
|
TN
|
07/12/2021
09/15/2021 (rev)
 TN Initial Plan for ARP Enhanced HCBS (PDF, 256.74 KB)
|
 TN ARP 9817 Partial 08-02-21 (PDF, 243.15 KB)
 TN ARP Conditional 09-22-21 (PDF, 213.36 KB)
 TN Q2 FY 2022 Conditional Approval (PDF, 264.85 KB)
|
TX
|
07/12/2021
09/21/2021 (rev)
10/26/2021 (rev)
 TX HCBS Spending Plan Narrative (PDF, 180.46 KB)
|
 TX ARP 9817 Partial 08-19-21 (PDF, 205.41 KB)
 TX Q2 FY2022 Conditional Approval (PDF, 255.89 KB)
|
UT
|
06/14/2021
09/30/2021 (rev)
 UT Spending Plan Narrative for HCBS Funding (PDF, 463.71 KB)
|
 UT ARP 9817 Partial 07-23-21 (PDF, 379.32 KB)
 UT ARP 9817 Addendum 08-02-21 (PDF, 161.66 KB)
 UT Q2 FY2022 Partial Approval (PDF, 286.47 KB)
|
VA
|
06/11/2021
10/18/2021 (rev)
 VA ARP HCBS Sec 9817 FFY22Q2 Spending Plan (PDF, 368.46 KB)
|
 VA ARP RAI 07-23-21 (PDF, 350.85 KB)
 VA ARP 9817 Addendum 08-02-21 (PDF, 160.61 KB)
 VA ARP 9817 Partial 09-13-21 (PDF, 377.14 KB)
 VA Q2 FY 2022 Partial Approval (PDF, 267.48 KB)
|
VT
|
06/14/2021
 Vermont HCBS FMAP Proposal (PDF, 565.94 KB)
|
 VT ARP 9817 Partial 07-23-21 (PDF, 348.21 KB)
 VT ARP 9817 Addendum 08-02-21 (PDF, 161.8 KB)
 VT Q2 FY2022 Partial Approval (PDF, 266 KB)
|
WA
|
06/11/2021
 WA State ARPA Spending Plan June 2021 (PDF, 478.26 KB)
|
 WA ARP 9817 RAI 07-23-21 (PDF, 297.09 KB)
 WA ARP 9817 Addendum 09-02-21 (PDF, 174.39 KB)
 WA ARP 9817 Partial 09-03-21 (PDF, 260.32 KB)
 WA Q2 FY 2022 Partial Approval (PDF, 266.81 KB)
|
WI
|
06/25/2021
11/01/2021 (rev)
 WI 20211101 APRA HCBS Quarterly Narrative and Spending Plan (PDF, 253.28 KB)
|
 WI ARP 9817 RAI 08-02-21 (PDF, 291.04 KB)
 WI ARP 9817 Conditional 09-03-21 (PDF, 286.73 KB)
 WI Q2 FY 2022 Conditional Approval (PDF, 264.94 KB)
|
WV
|
07/12/2021
08/12/2021 (rev)
 WV State ARP HCBS Initial Spending 08-12-21 (PDF, 511.87 KB)
|
 WV ARP 9817 RAI 08-02-21 (PDF, 272.31 KB)
 WV ARP 9817 Partial 09-02-21 (PDF, 237.99 KB)
 WV Q2 FY 2022 Partial Approval (PDF, 304.85 KB)
|
WY
|
07/08/2021
09/03/2021 (rev)
 Wyoming HCBS Initial Spending Plan (PDF, 2.97 MB)
|
 WY ARP 9817 Partial 08-09-21 (PDF, 180.43 KB)
 WY Q2 FY 2022 Conditional Approval (PDF, 270.37 KB)
|