Home & Community Based Services in Public Heath Emergencies

Home and community based services (HCBS) provide critical support to enable older adults, people with intellectual or developmental disabilities, physical disabilities, and/or mental illness to live in their own home or community. Emergency situations may necessitate changes to programs providing HCBS, particularly section 1915(c) HCBS waivers.

CMS encourages states to prepare for emergencies and ensure that acute and primary medical resources are available to meet the needs of individuals receiving these services. CMS encourages states to engage individuals and families in these efforts because assisting individuals prepare for emergency situations can be a key to successful system wide contingency planning.

When a disaster strikes, states should contact their CMS regional office or SOTA lead as soon as possible to discuss anticipated changes to waiver operations or needed authorities. Some examples of changes States may wish to request include changes to administrative activities, such as the establishment of a hotline, suspension of general Medicaid rules that are not addressed in 1915(c), such as payment rules, eligibility rules or suspension of provisions of 1902(a) to which 1915(c) is typically bound; creating an emergency person-centered service plan, expanding the provider qualifications and increasing the pool of providers who can render services. The state may not include changes not allowed under statute, such as the inclusion of room and board costs.

CMS will work with states to determine what changes may be needed while also providing key considerations, such as effective dates and impacts to other programs.