Home and community services

CMS announced that it does not anticipate taking enforcement action against states for Medicaid fee-for-service HCBS grievance-system requirements until December 31, 2027, while continuing to monitor person-centered service planning and HCBS settings compliance through existing oversight mechanisms.

Who it affects: Medicaid HCBS beneficiaries, family caregivers, disabled people, older adults, state Medicaid agencies

Why it matters: The grievance system is supposed to give HCBS beneficiaries a route to report problems with person-centered planning and settings requirements, but the enforcement-discretion period changes the near-term implementation posture for states and families.

• CMS CMCS Informational Bulletin on HCBS grievance enforcement discretion
• CMS Medicaid and CHIP Policy Implementation Roadmap

Last reviewed Jul 4, 2026

CMS's policy implementation roadmap and applicability-date chart identify phased HCBS Access Rule milestones, including HCBS website transparency, incident management, waiting-list and access reporting, HCBS Quality Measure Set reporting, and direct-care-worker payment adequacy requirements.

Who it affects: Medicaid HCBS beneficiaries, family caregivers, direct care workers, disabled people, older adults, state Medicaid agencies

Why it matters: Many caregiver-facing impacts of the Access Rule will appear through state implementation timelines, reporting systems, grievance operations, and direct-care workforce spending rather than through one immediate national change.

• CMS Medicaid and CHIP Policy Implementation Roadmap
• CMS Access Rule applicability-date chart
• CMS HCBS Access Rule provisions

Last reviewed Jul 4, 2026

CMS finalized the Medicaid Access Rule, including HCBS reporting on waiting lists and service timeliness plus phased direct-care compensation reporting and an eventual 80 percent payment-adequacy standard for certain HCBS services.

Who it affects: Medicaid HCBS recipients, older adults, disabled people, direct-care workers, family caregivers

Why it matters: This is a national implementation lane for whether Medicaid home-care dollars reach the workforce and whether states can show HCBS access problems clearly.

• CMS Access Rule fact sheet
• Federal Register Medicaid Access Rule

Last reviewed Jun 18, 2026

CMS's HCBS authorities page explains that states have several Medicaid HCBS options, including 1915(c) waivers, 1915(i) state plan HCBS, 1915(j) self-directed personal assistance services, and 1915(k) Community First Choice. CMS's HCBS quality page connects those authorities to quality measurement and quality-improvement work.

Who it affects: Medicaid HCBS beneficiaries, family caregivers, disabled people, older adults, state Medicaid agencies

Why it matters: A caregiver-facing corpus needs one federal guidance anchor that distinguishes the Medicaid authorities behind state waiver, self-direction, and community-first-choice pathways without turning the row into eligibility advice.

• CMS Medicaid HCBS authorities
• CMS HCBS quality

Last reviewed Jul 4, 2026

Public Law 119-21 section 71121 amends section 1915(c) of the Social Security Act so that, beginning July 1, 2028, the Secretary may approve a standalone waiver for home or community-based services under specified conditions, including a state showing that approval will not materially increase wait times for people under other 1915(c) waivers.

Who it affects: Medicaid HCBS beneficiaries, family caregivers, disabled people, older adults, state Medicaid agencies

Why it matters: This creates a future federal HCBS pathway that states may choose to pursue. The caregiver-facing question is not immediate eligibility, but whether and how states design new waiver options before the 2028 effective date.

• GovInfo Public Law 119-21 section 71121
• CMS Medicaid and CHIP Policy Implementation Roadmap

Last reviewed Jul 4, 2026

The Medicaid.gov waiver list shows the California Home and Community Based Alternatives Waiver (0139.R06.00) with status Approved, a CMS approval date of 07/14/2026, an effective date of 01/01/2023 and an expiration date of 12/31/2027. The Medicaid.gov California factsheet says it provides case management, home respite, facility respite, waiver personal care services, family and caregiver training, private duty nursing and continuous nursing services to individuals who are medically fragile or technology dependent, of any age, who meet a hospital, nursing facility, or ICF/IID level of care. The page also lists an Appendix K and its approval letter dated 07/14/2026.

Who it affects: medically fragile or technology-dependent people

Why it matters: Families deciding whether a California Medicaid waiver can pay for respite, in-home or caregiver supports need to know which approved waiver covers the person they care for and when its approval period ends.

• Medicaid.gov waiver list entry for 0139.R06.00
• Medicaid.gov California waiver factsheet

Last reviewed Oct 15, 2026

DHCS's Medi-Cal landing page describes Medi-Cal as free or low-cost health coverage for people who qualify and routes members to benefits, qualification, application, use, renewal, help, and contact pages. DHCS benefit pages list covered categories such as doctor care, hospital and clinic visits, dental and vision, medications, emergency care, laboratory services, rehab, mental health and substance-use services, transportation, and wellness care. DHCS's myMedi-Cal page says the guide explains how to apply, use benefits, and report changes, and links to county offices, Health Care Options, transportation, Medi-Cal Dental, IHSS, fair-hearing, and other program resources. DHCS's Help page explains that DHCS oversees Medi-Cal, county offices manage most cases, and the Benefits section includes essential health benefits, in-home care, transportation, and home- and community-based services.

Who it affects: Medi-Cal applicants, Medi-Cal members, family caregivers, older adults, disabled people, children, pregnant people

Why it matters: Caregivers need an official California navigation layer for benefits, county routing, managed-care choices, transportation, dental, in-home supports, and HCBS before helping someone apply, renew, call a plan, or escalate a coverage problem.

• DHCS Medi-Cal
• DHCS Medi-Cal Benefits
• DHCS my Medi-Cal guide page
• DHCS Medi-Cal Help

Last reviewed Jul 4, 2026

Colorado's official Code of Colorado Regulations document list places Medical Assistance rules in 10 CCR 2505-10. The listed sections include eligibility, provider screening and NPI; physician, dental, vision, Medicaid managed care, and EPSDT services; hospital services; long-term care, nursing facility care, and adult day care; home health, hospice, oxygen, and durable medical equipment; case management; pharmaceuticals; and home- and community-based services. The Secretary of State rule pages identify the CCR as the official publication of state administrative rules and list current effective rule versions for 8.100 eligibility and 8.7000 home and community-based services.

Who it affects: Health First Colorado applicants, Health First Colorado members, family caregivers, HCBS recipients, long-term care recipients, Medicaid providers

Why it matters: This is the official regulatory layer beneath Colorado Health First Colorado applications, eligibility, covered services, long-term care, home/community supports, managed care, provider participation, and service-rule explainers.

• Colorado CCR Medical Assistance document list
• 10 CCR 2505-10 8.100 Eligibility, Provider Screening, NPI
• 10 CCR 2505-10 8.7000 Home and Community Based Services

Last reviewed Jul 4, 2026

The official HUSKY gateway identifies HUSKY Health as Connecticut Medicaid and CHIP coverage for children and adults, including children, parents, relative caregivers, elders, individuals with disabilities, adults without dependent children, and pregnant women. DSS's healthcare page says HUSKY Health encompasses Medicaid and CHIP, lists HUSKY A, B, C, and D categories, and points members to handbooks, care management, provider information, state plan amendments, waivers, application routes, and benefits overview pages. The benefit overview lists common covered categories such as preventive care, doctor visits, long-term services and supports, home health care, hospice, dental, behavioral health, pharmacy, and non-emergency transportation for HUSKY A, C, and D members. HUSKY Health member pages provide handbooks, benefit grids, Quick Guides, program identification on the member ID card, and Member Engagement Services contact routes. DSS's HCBS page lists state-plan and waiver community options, including Community First Choice, CHCPE, Katie Beckett, Money Follows the Person, PCA Waiver, and DDS waivers.

Who it affects: HUSKY Health applicants, HUSKY Health members, children, parents, relative caregivers, older adults, disabled people, pregnant people, family caregivers

Why it matters: Caregivers need a trusted Connecticut navigation layer for what HUSKY category a person is in, where to find benefit details, which member handbook or guide applies, and which official path handles medical, dental, behavioral health, pharmacy, transportation, long-term services, or HCBS questions.

• Connecticut HUSKY Health gateway
• Connecticut HUSKY benefit overview
• Connecticut DSS healthcare coverage
• HUSKY Health member benefits and handbooks
• Connecticut DSS home and community-based services overview

Last reviewed Jul 4, 2026

DHSS says most Medicaid benefits are delivered through Diamond State Health Plan managed-care organizations under contract with the state, while prescription benefits and non-emergency transportation are covered directly by Medicaid instead of the MCO. DHSS identifies MCO choice and assignment rules, categories of people not enrolled in MCOs, and the Section 1115 waiver context for DSHP. DHSS eligibility, HCBS, and forms/publications pages identify Medicaid program categories, long-term HCBS options that help people remain at home or in assisted living instead of a nursing facility, Lifespan Waiver community alternatives, and Medicaid State Plan attachments for services and eligibility.

Who it affects: Delaware Medicaid members, Diamond State Health Plan members, Diamond State Health Plan Plus members, long-term services and supports users, HCBS participants, people with disabilities, older adults, family caregivers

Why it matters: Caregivers need a single Delaware orientation layer before drilling into plan choice, carved-out benefits, HCBS service categories, waiver services, transportation, or state-plan coverage. This row marks the official member-guidance surface for later service-specific explainers.

• DHSS Diamond State Health Plan
• DHSS Delaware Medicaid Eligibility
• DHSS Home and Community Based Services
• DHSS Forms and Publications

Last reviewed Jul 4, 2026

Florida Statutes section 409.902 designates AHCA as the single state agency authorized to make medical-assistance payments under Title XIX, designates the program as Medicaid, and makes DCF responsible for Medicaid eligibility determinations, including policy, rules, SSI-related agreements, and actual determinations. Section 409.904 authorizes optional payments for eligible people subject to federal and state income, asset, and categorical tests and includes institutional, hospice, home- and community-based, medically needy, emergency, family-planning, child, premium, and related coverage categories. Section 409.905 identifies mandatory Medicaid service authority, including home health services and private duty nursing utilization management, and section 409.906 identifies optional service authority including home- and community-based services and assistive-care services.

Who it affects: Florida Medicaid applicants, Florida Medicaid recipients, Statewide Medicaid Managed Care enrollees, older adults, people with disabilities, children, family caregivers, providers

Why it matters: Florida's statutory layer is the authority behind eligibility, service coverage, payment, managed care, and long-term-care implementation. This row gives Florida coverage explainers a legislative anchor before service-specific statutes are promoted.

• Florida Statutes Chapter 409 Part III, Medicaid
• Florida Statutes Section 409.902
• Florida Statutes Section 409.904
• Florida Statutes Sections 409.905 and 409.906

Last reviewed Jul 4, 2026

Florida implemented the SMMC 3.0 contract cycle and continues to administer Long-Term Care program enrollment, plan selection, and coverage policy through AHCA.

Who it affects: older adults, people with disabilities, Medicaid long-term care members, family caregivers, managed care plans

Why it matters: For families, the practical work is understanding eligibility, plan choice, welcome letters, provider networks, and how long-term care services are coordinated.

• Florida AHCA Statewide Medicaid Managed Care
• Florida AHCA SMMC Long-term Care Program
• Florida SMMC long-term care plan selection

Last reviewed Jun 19, 2026

Illinois HFS lists the Persons who are Elderly waiver as one of the state's HCBS waivers, designed to help eligible people remain at home or in community settings instead of institutional care.

Who it affects: older adults, family caregivers, Medicaid members, people at risk of nursing facility placement, home-care providers

Why it matters: This is a concrete home-care pathway for caregivers comparing in-home service, adult day service, emergency response, and nursing-facility alternatives.

• Illinois HFS HCBS waiver programs
• Illinois HFS Persons who are Elderly waiver
• Medicaid.gov Illinois waiver factsheet

Last reviewed Jun 18, 2026

Maryland's waiver remains a home- and community-based pathway that can cover services such as assisted living, case management, medical day care, respite care, family training, and nutrition supports.

Who it affects: older adults, adults with physical disabilities, family caregivers, Maryland Medicaid participants, people at nursing-facility level of care

Why it matters: Caregivers need a plain-language way to compare waiver eligibility, available services, and waitlist/application steps with facility-care alternatives.

• Maryland Medicaid HCBS waiver regulatory information
• Medicaid.gov Maryland waiver factsheet

Last reviewed Jun 18, 2026

Massachusetts continues to operate the Frail Elder Waiver as an HCBS pathway for older adults who meet clinical and financial eligibility rules and want supports outside an institution.

Who it affects: older adults, family caregivers, MassHealth members, frail elders, aging-service providers

Why it matters: For caregivers, the practical issue is not just whether a waiver exists; it is whether the family can understand eligibility, service planning, and how home supports compare with facility care.

• Mass.gov Frail Elder Waiver applicant and participant information
• Mass.gov Frail Elder Waiver

Last reviewed Jun 18, 2026

DMAHS describes MLTSS as expanding home- and community-based services and coordinating long-term services and supports through NJ FamilyCare managed care, while the PPP page describes self-directed services that can let qualifying members choose workers, including trusted individuals such as friends, relatives, or neighbors.

Who it affects: NJ FamilyCare members, older adults, disabled people, family caregivers, authorized representatives

Why it matters: This is the official guidance bridge between New Jersey's managed long-term-care model and self-directed personal care, but it should not be used as a stand-alone eligibility determination.

• NJ DMAHS Managed Long Term Services and Supports
• NJ DMAHS Personal Preference Program
• NJ DMAHS MLTSS application guidance

Last reviewed Jul 4, 2026

N.J.A.C. 10:60 explains the rules for New Jersey fee-for-service home care services and includes home health services, personal care assistant services, 1915(c) waiver programs, and MLTSS under the New Jersey 1115 Comprehensive Medicaid Waiver.

Who it affects: Medicaid home-care beneficiaries, NJ FamilyCare members, family caregivers, home health agencies, health care service firms

Why it matters: The regulation is the state rule anchor behind Medicaid home-care service administration. It should be paired with current MLTSS/PPP guidance before giving caregiver-facing navigation help.

• N.J.A.C. 10:60 Home Care Services
• NJ DMAHS Managed Long Term Services and Supports

Last reviewed Jul 4, 2026

Oregon continues to operate OPI as an in-home service pathway, alongside Medicaid-linked OPI-M rules under the state's long-term services infrastructure.

Who it affects: older adults, people with disabilities, family caregivers, people needing in-home help, aging network partners

Why it matters: Home-care supports can determine whether families can avoid facility placement, reduce unpaid caregiver time, or bridge gaps when full Medicaid LTSS is not yet available.

• Oregon DHS Oregon Project Independence
• Oregon Secretary of State OPI-M rules

Last reviewed Jun 18, 2026

Pennsylvania DHS is moving a Community HealthChoices 1915(c) HCBS waiver amendment into a July 1, 2026 effective window.

Who it affects: older adults, adults with physical disabilities, family caregivers, Medicaid long-term services users, dual-eligible members

Why it matters: CHC is the long-term services and supports pathway many caregivers encounter when trying to keep an older adult or disabled adult supported outside a facility.

• Pennsylvania DHS Community HealthChoices application
• Pennsylvania DHS CHC waiver amendment

Last reviewed Jun 18, 2026

Texas continues to route many older adults and adults with disabilities through STAR+PLUS managed care for acute care and long-term services and supports, with separate HCBS waiver pathways for additional community supports.

Who it affects: older adults, adults with disabilities, Medicaid members, family caregivers, managed care plans

Why it matters: Caregivers in Texas need to understand managed-care plan choice, service coordination, HCBS interest-list steps, and what supports can keep someone out of an institution.

• Texas HHS STAR+PLUS
• Texas HHS STAR+PLUS waiver handbook section

Last reviewed Jun 19, 2026

Virginia maintains CCC Plus as a major HCBS route and posted 2026 waiver amendment materials through its public regulatory process.

Who it affects: older adults, people with physical disabilities, chronically ill adults, Medicaid members, family caregivers

Why it matters: Caregivers need to know whether CCC Plus can support home care, how Medicaid eligibility and waiver screening work, and where waiver changes may affect service continuity.

• Virginia Medicaid CCC Plus Waiver
• Virginia Regulatory Town Hall CCC Plus waiver notice

Last reviewed Jun 19, 2026

Washington's COPES waiver remains a home- and community-based services pathway covering supports such as adult day services, training, community support, equipment, meals, skilled nursing, and transportation for eligible members.

Who it affects: older adults, adults with disabilities, family caregivers, Apple Health members, people at nursing-facility level of care

Why it matters: COPES is a practical home-care route caregivers need to understand when comparing in-home support, adult family homes, assisted living, and nursing-facility placement.

• Washington DSHS HCBS rules and waivers
• Medicaid.gov Washington waiver factsheet

Last reviewed Jun 18, 2026