Lengthy new regulations from the federal government can make you want to pull the covers over your head. But a batch released Friday may provide some comfort to people in Medicaid who are getting long-term services and supports at home or in their communities. These services, such as help with chores, personal care and transportation, enable people living with chronic illnesses and disabilities to stay connected to their communities and out of hospitals and nursing homes.

The regulations on Home and Community Based Services (HCBS) in Medicaid are designed to ensure these services really promote community living. They apply to HCBS provided through three federal mechanisms – 1915(c) HCBS waivers, 1915(i) HCBS state plans, and 1915(k) Community First Choice. In all of these cases, the federal government shares the cost of services with the states. OK, enough with the technical details. Let’s get to the good stuff.

Here are some highlights:

  • There’s a clearer and consistent definition for person-centered planning for HCBS, which should benefit consumers. The rules require the planning process be “directed by the individual with long-term support needs,” something Community Catalyst and other advocates have promoted. In addition, the resulting personal care plan must focus on the individual’s goals and preferences, including goals for participation in community activities, work and education as well as health and wellness goals.
  • There’s more focus on consumer choice and independence in the places where people can live and get HCBS. The consumer must be given options for choice of housing, and all options must facilitate autonomy and independence, and ensure dignity and respect. In most cases, the consumer must also be able to freely choose who provides their HCBS services.
  • States face stronger requirements to get public input on changes in waivers or state rules, although states have more flexibility in how they carry this out than we would like.
  • States will need to submit public plans within a year on how they will upgrade existing programs to meet the new definitions and requirements. They will have up to five years to make the changes.
  • The Centers for Medicare and Medicaid Services (CMS) have new tools for enforcing state compliance with the requirements including withholding payment for waiver services or halting enrollments. Previously, CMS’ only enforcement option was to end a waiver, a severe penalty that was rarely imposed.

For those who want more details, we recommend taking a look at the CMS webpage on this topic, including the rules themselves and four fact sheets. CMS will host a webinar on the rules January 23 from 1-3, which will be repeated January 30 at the same time. Details on how to register will be posted on the webpage.

Several of our advocacy partners are doing detailed analyses, and we will share links to those when they are complete. There undoubtedly will be some additional tweaks needed, and advocates will need to join CMS in monitoring implementation of the changes. But overall, we can rest assured that these regulations provide more comfort than cause for concern.