Home and Community Based Services

What are Home and Community Based Services?
Health care reform included several provisions to expand home and community based services offered through state Medicaid programs. These provisions will make it easier for people living with spinal cord injury and paralysis to live at home and continue to participate in their communities, rather than being forced to receive needed services in an institutional setting.

Home and Community Based Services (HCBS) in Medicaid
Under prior law, states were required to apply for a Medicaid waiver from the Department of Health and Human Services (HHS) in order to offer home and community based services through their state Medicaid programs. Health reform simplified this process by allowing states to more easily amend their state plan without applying for a waiver.

Community First Choice Option (CFC)
Created by the new health reform law, the Community First Choice Option will provide comprehensive home and community-based attendant services and supports for people who are eligible for an institutional level of care. Under the new option, states are encouraged to offer these services as a rule, rather than an exception, for Medicaid-eligible individuals with disabilities and with incomes up to 150% of the federal poverty level.

Recent Action:
Expansion of the HCBS state plan option went into effect in October 2010 and, on May 7, 2012, the Centers for Medicare and Medicaid Services (CMS) published a final rule implementing the CFC option.

What's Next?
The Reeve Foundation strongly believes that no one should be forced to choose between living at home and receiving the services they need. Over the coming months, we will work to encourage States to take advantage of efforts under health reform to increase access to home and community based services for people living with spinal cord injury and paralysis.