New federal Medicaid rules, for the first time, set standards to ensure that Medicaid-funded home and community-based services (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 health care programs.
The National Senior Citizens Law Center (NSCLC) has developed a guide to the new rules, entitled Just Like Home: An Advocate’s Guide to Consumer Rights in Medicaid HCBS. The Guide’s discussion and analysis include the rules themselves, along with commentary and subsequently-issued guidance from the Centers for Medicare and Medicaid Services, 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.
NSCLC is available to assist consumer advocates in thinking through the issues and developing state-specific recommendations. Under Medicaid law, HCBS funding exists to give consumers the ability to receive necessary long-term services and supports 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.