Medicaid Home and Community Based Services

On January 16, 2014, the Centers for Medicare & Medicaid Services (CMS) posted in the Federal Register their Final Rule for Medicaid Home and Community Based Services (HCBS). The rule will be effective March 17, 2014. HCBS refers to services that States can cover under Medicaid to help people with disabilities achieve independence and recovery in and around their homes in the community—services like case management, personal care and habilitation (assistance with gaining socialization and independent living skills). USICH identifies HCBS as one of the most promising ways that States can use Medicaid to cover many of the services delivered in permanent supportive housing for people experiencing chronic homelessness.

The regulation clarifies the qualities of settings where individuals can receive HCBS, in essence defining what it means for a setting to be “community based” and preventing its use in institutional settings. Community settings possess qualities like integration in the community and ensure individual rights of privacy, and optimize autonomy and independence. The regulation also outlines additional requirements for settings in which the service provider is also the building owner or operator, requirements like ensuring that tenants have leases, have freedom to furnish and decorate their units, and the ability to have visitors. 

The qualities of HCBS settings outlined in the Final Rule closely match the characteristics and qualities of permanent supportive housing—the cornerstone of the strategy for ending chronic homelessness.  As such, these regulations open the door even further for States to use HCBS to cover services in permanent supportive housing for people with disabilities experiencing homelessness. In addition, the regulations provide States with more flexibility to provide expanded home and community based services and to target services to specific populations. USICH encourages States to consider how HCBS, through the 1915i State plan option, can help create services to end chronic homelessness.

The full text of the final regulation can be found here. CMS also released helpful fact sheets that summarize the regulations.  CMS will be holding informational webinars in the next several weeks.  Questions regarding the final regulation can be submitted to For a hard-copy “primer” providing more general information on Medicaid HCBS, contact, and provide your name, mailing address, and number of copies requested.