Authorities

HCBS first became available in 1983 when Congress added section 1915(c) to the Social Security Act, giving States the option to receive a waiver of Medicaid rules governing institutional care. In 2005, HCBS became a formal Medicaid State plan option. Several States include HCBS services in their Medicaid State plans. 47 States and DC are operating at least one 1915(c) waiver.

State Medicaid agencies have several HCBS options:

• 1915 (c) Home and Community-Based Waivers
• 1915(i) State Plan Home and Community-Based Services
• 1915(j) Self-Directed Personal Assistance Services Under State Plan
• 1915(k) Community First Choice

CMS works with States to assure and improve quality in Medicaid HCBS waiver programs. See page on quality monitoring of HCBS waivers for more information

CMS has developed the following reports that highlight promising practices in home and community-based services offered by States to enable persons of any age who have a long-term illness or disability to live in the most integrated community setting appropriate to their individual support requirements and preferences.