Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Supporting Individuals to Live in Their Own or Family Home


In-home supports provide an alternative living arrangement to provider-controlled residential programs. In-home supports are individually tailored services that assist individuals to live in their own home or in their family’s home. In-home supports may comprise a variety of services such as residential habilitation, personal care, homemaker/chore services, skills training, family training, respite, and housing modifications. In the past, in-home supports for individuals living in their own home (a place they lease or own) were reserved for individuals deemed capable of “independent” living. The model offered intermittent supports to individuals who needed some assistance with activities of daily living or some limited skills training or supervision in order to live independently.

In the ID/DD field, this model has changed dramatically; even individuals who need around-the-clock supports can now live in their own home. The opportunity to own or lease a home (or apartment) is no longer reserved only for those individuals needing minimal supports. Now, individuals live with roommates and have either live-in or come-in support personnel to assist them. This type of arrangement is often referred to as “supported living.” The intensity, type, and frequency of supports are based on the person’s needs and can be a combination of support, supervision, and skills training based on the person’s individual service plan.

For individuals living in their family’s home, similar services can be brought in to assist the individual, and other supports, such as respite and caregiver training, can be made available to the family. These supports help families to keep individuals in the family home rather than seeking out-of-home placement in facilities that are provider owned or operated.

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