Just Like Home: Consumer Rights in Medicaid HCBS

April 2014 — The National Senior Citizens Law Center (NSCLC) believes that home and community-based services (HCBS) should be provided as an option to every Medicaid beneficiary (consumer) who needs such services, allowing more seniors and persons with disabilities to live with dignity and independence in their homes.   Under Medicaid law, HCBS funding exists to give consumers the ability to receive necessary long-term services and supports (LTSS) without moving into a nursing home or other healthcare institution.  The value of the HCBS alternative would be destroyed or diluted if HCBS were provided in institution-like settings.

New federal Medicaid rules, for the first time, set standards to ensure that Medicaid-funded HCBS are provided in settings that are non-institutional in nature.  These standards, which took effect in March 2014, apply to residential settings such as houses, apartments, and residential care facilities like assisted living facilities.  The standards also apply to non-residential settings such as adult day care programs.

This guide provides consumers, advocates and other stakeholders with information regarding multiple facets of the new standards, including consumer rights in HCBS, and the guidelines for determining which settings are disqualified from HCBS reimbursement.  This guide is based on the federal rules and subsequently issued guidance, and will be updated as further information becomes available.

Importantly, many details remain to be determined by individual states, subject to review and approval by the federal government.  Stakeholder involvement and advocacy will be critical as state Medicaid programs transition through implementation of the new rules.  Throughout the transition process, both the states and the federal Centers for Medicare and Medicaid Services (CMS) must accept and consider recommendations from consumers and other stakeholders.

About Justice in Aging

Justice in Aging is a national non-profit legal advocacy organization that fights senior poverty through law. Formerly the National Senior Citizens Law Center, since 1972 we’ve worked for access to affordable health care and economic security for older adults with limited resources, focusing especially on populations that have traditionally lacked legal protection such as women, people of color, LGBT individuals, and people with limited English proficiency.