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


We are pleased to present this updated version of the Medicaid Home and Community Services Primer. Over the past 10 years, the Primer has fulfilled its primary purpose of informing key stakeholders about the statutes and regulations governing the financing and provision of Medicaid home and community services. Specifically the Primer was designed:

  • To explain how the Medicaid program can be used to expand access to a broad range of home and community services and supports for people of all ages with disabilities, and to promote consumer authority and control over their services; and
  • To encourage a fundamental approach to the support of people with disabilities that minimizes reliance on institutions and maximizes community integration in the most cost-effective manner.

Medicaid policy has continued to evolve over the last 10 years to better support options for community living by people of all ages with disabilities and/or chronic health conditions. The Deficit Reduction Act of 2005 and the Patient Protection and Affordable Care Act of 2010 both created new options for states to provide home and community services without having to secure a federal waiver. In addition, the Centers for Medicare & Medicaid Services (CMS) has made numerous changes to the program to make it easier for individuals to live in the community, such as authorizing coverage of one-time transition expenses for home and community-based services (HCBS) waiver participants.

The current edition of the Primer has been updated to include all relevant statutory, regulatory and other policy changes that have occurred in the last 10 years. Given the significance of the recent changes in Medicaid, I believe the Primer will be an ever more useful tool for all those working to ensure that people with disabilities can live in the most integrated settings appropriate to their needs.

This updated version of the Primer would not have been possible without the commitment and hard work of many people. In particular I want to recognize and thank the CMS staff who took time out of their busy schedules to review each chapter of the Primer to ensure that the content was accurate and consistent with current policy.

As the Medicaid program continues to evolve to better meet the needs of its beneficiaries, new policy and clarifications of existing policy will be made subsequent to the publication of the Primer. Information about policy changes will be disseminated through State Medicaid Director Letters, the Federal Register, and the State Medicaid Manual, which are available on the CMS website.

Richard Frank
Deputy Assistant Secretary for Planning and Evaluation
Disability, Aging, and Long-Term Care Policy

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