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Employment & HCBS

States can provide specific employment supports to individuals through Home and Community Based Services (HCBS) under Section 1915(c) waivers or Section 1915(i) state-plan services 1915(c) waivers provide long-term care for individuals who would receive institutional care without a waiver. 1915(i) services provide HCBS to individuals who meet state-defined criteria.

Services available through HCBS are more comprehensive than those available in standard Medicaid benefits packages. HCBS services provide states with the opportunity to offer services that specifically support an employment goal or outcome, through what are called habilitation services. Habilitation services are covered as part of HCBS in both 1915(c) and 1915(i) benefits. Supported employment services may be furnished as an expanded habilitation service under the provisions of §1915(c)(5)(C) of the Act. It may be offered to any target group for whom the provision of these services would be beneficial in helping them to realize their goals of obtaining and maintaining integrated community employment.

CMS defines habilitation as "services designed to assist participants in acquiring, retaining and improving the self-help, socialization and adaptive skills necessary to reside successfully in home and community-based settings." Habilitation services are flexible in nature, and can be specifically designed to fund services and supports that assist an individual to obtain or maintain employment. It is important, however, to note that employment services available to an individual through other programs, such as Vocational Rehabilitation cannot be provided through Medicaid.

The self-directed service delivery models can also be used to provide employment supports. In a self-directed model, individuals may hire their own job coaches and employment support staff, rather than relying exclusively on agency based staffing models. This may be particularly useful as individuals seek to expand the pool of people who can provide employment supports and services to include friends, family members, co-workers and other community members that do not view themselves as part of the traditional Medicaid agency based employment supports workforce.