HCBS Regulations and Medicaid Waviers

Home and Community-Based Services (HCBS) Regulations

The final HCBS regulations (known as the “Final Rule”) were:

  • Published in the Federal Register on January 16, 2014; they became effective March 17, 2014
  • Designed to enhance the quality of HCBS, provide additional protections, and ensure full access to the benefits of community living
  • Establish requirements for the qualities of settings where individuals live and/or receive Medicaid-reimbursable HCBS provided under sections 1915(c), 1915(i), 1915(k), 1915(b)(3), and 1115 of the Social Security Act
  • Focus on the quality of individuals’ experiences

The intent is that individuals receiving Medicaid-funded HCBS have the opportunity to receive these services in a manner that protects individual choice and promotes community integration

  • Any residential or non-residential setting where individuals live and/or receive HCBS must have the following five qualities by March, 2019:
    • Is integrated in and supports full access of individuals to the greater community
      • Provides opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and
      • Ensures that individuals receive services in the community, to the same degree of access as individuals not receiving HCBS
    • Is selected by the individual from among setting options including non-disability specific settings and options for a private unit in a residential setting
    • Ensures an individual’s rights of privacy, dignity and  respect, and freedom from coercion and restraint
    • Optimizes individual initiative, autonomy, and independence in making life choices, including, but not limited to, daily activities, physical environment, and with whom to interact
    • Facilitates individual choice regarding services and supports, and who provides them

Medicaid Waivers

For a valuable explanation on Medicaid Waivers and Long Term Services and Supports visit https://risp.umn.edu. Scroll down to “Current Report” and click on “Residential Information Systems Project Annual Report: Status and Trends Through 2016.” Go to the following pages:

Pg. 87 – The Medicaid Program

Pg. 90 – HCBS

Pg. 91 – Long Term Services and Supports (LTSS)

Pg. 93 – Self -Directed Services

*Self-Directed Services allow participants, or their legal representatives, to exercise decision-making authority and management responsibility over services. Recipients can choose their service provider and direct supports and services. (https://www.medicaid.gov/medicaid/ltss/self-directed/index.html).

Contact your state’s Division of Developmental Disabilities department to access waiver-funded services.


Data from Centers for Medicare & Medicaid Services “Home & Community-Based Settings, Excluded Settings, and the Heightened Scrutiny Process” presentation dated 11-4-2015.


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