Policy/Initiative Type: Medicaid

California DDS Fact Sheet: Home and Community Based Setting Rule

“The purpose of the rules is to ensure that individuals receive services in settings that are integrated in and support full access to the greater community. This includes opportunities to seek employment and work in competitive and integrated settings, engage in community life, control personal resources, and receive services to the same degree as individuals who do not receive regional center services. It means that settings need to focus on the nature and quality of individuals’ experiences and not just about the buildings where the services are delivered. Individuals have an active role in the development of their plan, the planning process is person-centered, and the plan reflects the individual’s service and supports and what is important to them.”

Links:

California DDS Fact Sheet: Home and Community Based Setting Rule

Colorado HCBS Settings Final Rule Provider Transition Plan (PTP) User Manual

Developed to Assist Providers in Completing the PTP on the Google Cloud/G-Suite Platform
“In order to demonstrate to CMS that Colorado has attained statewide compliance with the HCBS Settings Final Rule, the Department needs providers to complete a PTP for each setting where individuals live or receive HCBS. This includes:

  • Adult day service programs (basic and specialized)
  • Alternative care facilities (ACFs)
  • Child Residential Habilitation Program (CHRP) settings, including foster care homes, kinship foster care, non-certified kinship care, specialized group facilities (SGFs), including group homes and group centers, and residential child care facilities (RCCFs)
  • Day habilitation programs, including Specialized Habilitation, Supported Community Connections (SCC), and prevocational services
  • Day treatment facilities
  • Group homes
  • Individual Residential Services and Supports (IRSS) settings, including host homes and Personal Care Agencies (PCAs)
  • Group supported employment programs
  • Supported Living Program (SLP) facilities
  • Transitional Living Program (TLP) facilities.”

 

Links:

Colorado HCBS Settings Final Rule PTP User Manual (PDF)

New Hampshire Granite Advantage Health Care Program (1115 Demonstration)

“This demonstration provided the Department with the authority to test an approach to promoting community engagement and work by instituting community engagement requirements as a condition of Granite Advantage eligibility. Granite Advantage beneficiaries in the new adult group must work or engage in other specified activities, including vocational educational training, job training, or job search activities, for at least 100 hours per month to maintain eligibility for coverage in the new adult group, unless they meet exemption criteria established by the Department or demonstrate good cause for failing to meet the community engagement requirements. If Granite Advantage beneficiaries failed to meet these requirements for two consecutive months, their Medicaid eligibility would have been suspended. The Granite Advantage Health Care Program demonstration is not enforceable at this time.”

Links:

New Hampshire Granite Advantage Health Care Program (1115 Demonstration)
New Hampshire Granite Advantage Health Care Program (2018, PDF)

South Dakota Statewide Transition Plan (HCBS)

“Home and community based services (HCBS) in South Dakota have been historically provided through four1915(c) HCBS Waivers. Each waiver targets a specific population and provides a menu of services to meet the needs of the target population. South Dakota has structured its waivers to meet the needs of individuals who live in rural and frontier areas. As the state Medicaid agency, the Department of Social Services provides oversight to all of South Dakota’s Medicaid waivers.”

Links:

South Dakota Statewide Transition Plan (PDF)

Iowa HCBS Provider Quality Management Self- Assessment

“This form is required for entities enrolled to provide services in Section B under the following waivers/programs:

  • Health and Disability (HD)
  • Elderly Waiver
  • Brain Injury Waiver (BI)
  • AIDS/HIV Waiver
  • Children’s Mental Health Waiver (CMH)
  • Physical Disability Waiver (PD)
  • Intellectual Disability Waiver (ID)
  • HCBS Habilitation Services (Hab)

Each provider is required to submit one, six-section self-assessment.”

Links:

Iowa HCBS Provider Quality Management Self- Assessment

Texas Promoting Independence Plan

“The Promoting Independence Plan is Texas’ comprehensive response to the Supreme Court’s 1999 Olmstead decision, but also outlines a vision and guiding principle for the Health and Human Services Commission to provide a system of holistic services and supports that foster independence and self-determination for people with disabilities so that they may be able to live fully integrated into their chosen communities.”

Links:

Texas Promoting Independence Plan
Texas Promoting Independence Initiative

New Hampshire Statewide Transition Plan

“New Hampshire has drafted a Statewide Transition Plan to show how it will establish compliance with these new regulations. New Hampshire’s draft Statewide Transition Plan includes several sections: 1) Inventory – review of existing state standards, policies, regulations, and statute to determine state level changes that are needed to align with the federal requirements, 2) Assessment – Development, implementation and validation of assessments completed by providers and participants including remediation plans and the role of the Advisory Task Force, 3) Ongoing Monitoring and Compliance.“

 

Links:

New Hampshire Statewide Transition Plan

Kansas Medicaid Extension Section 1115(a) Demonstration KanCare (Project Number 11-W-00283/7)

“Kansas will provide new employment supports to beneficiaries with behavioral health diagnoses and eligible for a 1915(c), either by being on the waitlist or already being enrolled in the 1915(c). This voluntary pilot will be capped at 500 beneficiaries. Services will include pre-vocational support services, supportive employment services, personal assistant services, independent living skills training, assistive technology, and transportation, and are similar to services that could be offered as state plan home and community-based services (HCBS) benefit under section 1915(i) of the Social Security Act (the Act). Included in the pilot is a targeted expansion of Medicaid for individuals on Social Security Disability Insurance (SSDI) who would normally not be eligible for Medicaid without meeting spend-down requirements and these beneficiaries will be eligible for both the pilot services and Medicaid state plan services.“

Links:

Kansas Medicaid Extension Section 1115(a) Demonstration KanCare (PDF)

Texas Medicaid and CHIP Reference Guide (2024)

Medicaid Buy-In for Adults

The Medicaid Buy-In (MBI) for Adults program offers low-cost Medicaid services to adults with disabilities who work. Adults may qualify if they meet all the following criteria:

  • They have a disability (the MBI program uses the Social Security disability guidelines to determine if applicants have a disability).
  • They are working and meet the income limits for the program.
  • They are not continuously living in a state institution or nursing facility.

The 2024 income limit for MBI is $3,138 per month. Countable assets must total no more than $2,000. Only earned income is counted toward this income limit. Unearned income is only considered in the calculation of the monthly premium, not eligibility.

Links:

Texas Medicaid and CHIP Reference Guide (2024, PDF)
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