Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Optional State Plan Home and Community-Based Services


The DRA-2005 added §1915(i) to the Social Security Act, which was amended by the Patient Responsibility and Affordable Care Act of 2010. The §1915(i) authority gives states the option to offer a wide range of home and community-based services without having to secure Federal approval of a waiver. The §1915(i) authority provides states an opportunity to offer services and supports before individuals need institutional care, and also provides a mechanism to provide State Plan HCBS to individuals with mental health and substance use disorders.

Unlike other State Plan services, under §1915(i), states may design service packages without regard to comparability.37 States may offer HCBS to specific, targeted populations and offer services that differ in amount, duration, and scope to specific population groups, including eligibility groups as authorized under §1915(i)(6)(c), either through one or multiple §1915(i) service packages. Services must be available statewide.

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