Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Introduction


Changes in Federal Medicaid statute and policy over the past three decades have made it feasible for states to provide a wide range of home and community services. The many options for furnishing these services can be confusing for policymakers, state officials, advocates, and consumers alike, as they can be funded through one or more of three alternative routes: (1) a state’s regular Medicaid State Plan, (2) managed care programs, and/or (3) one or several HCBS waiver programs, each offering a distinct package of services and supports to different groups of individuals.2

Combining these alternatives in creative ways can give states substantial latitude in designing their Medicaid home and community service coverages and customizing benefit packages to meet the needs of particular groups. Use of HCBS waivers also provides considerable flexibility for states to manage service costs and the number of people served. This flexibility explains the considerable variation in the services and supports that states offer.

This chapter begins with an overview of the broad types of Medicaid home and community services and supports a state may offer. It then describes major Federal and state considerations that can influence decisions concerning whether to offer a service as a regular Medicaid program benefit or through an HCBS waiver program. The chapter concludes with more detailed descriptions and illustrations of coverage options--focusing first on services that may be offered under the regular Medicaid State Plan and then on services that may be offered under an HCBS waiver program.

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