Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Level-of-Care Criteria and State Regulation of Residential Care Facilities


HCBS waiver regulations require that any facility in which waiver services are furnished must meet applicable state standards regarding provider qualifications and methods to ensure oversight and monitoring of the facilities. As noted above, states must include a description of these standards and provider qualifications in the HCBS waiver application.33 When services are furnished by a residential care facility, it must meet the standards for service provision that are set forth in the approved waiver documents.

Thus, states planning to cover services in residential care facilities through an HCBS waiver program need to be sure that the admission and retention provisions of state licensing or certification requirements permit facilities to serve individuals who meet Medicaid’s nursing home or ICF/ID level-of-care criteria. Licensing must also address a facility’s qualifications to provide the services needed by Medicaid beneficiaries.

States that use a waiver program to provide services in residential care settings need to contract with facilities that are willing and able to provide the services needed by individuals who meet the state’s Medicaid nursing facility level-of-care criteria, which --if stringent--may be extensive.

View full report


"primer10.pdf" (pdf, 2.08Mb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®