New Guidance on HCBS Settings Rule
As explained in a March 22 press release, the Centers for Medicare and Medicaid Services (CMS) has issued updated guidance to State Medicaid Directors on implementation of the 2014 Home and Community Based Services (HCBS) regulation. The guidance is in the form of a letter to State Medicaid Directors and Frequently Asked Questions (FAQs), SMD # 19-001 Re: Home and Community-Based Settings Regulation – Heightened Scrutiny. The FAQs also clarify two other topics that have often been raised with CMS: whether an individual’s private residence should be assessed for compliance with the settings criteria, and whether an individual should reside in a compliant setting in order to receive Medicaid reimbursement for non-residential HCBS.

In other news: CMS granted a waiver to Utah to partially expand Medicaid with a work requirement, and issued new guidance for states seeking Section 1115 Medicaid waivers. (See below.)


Status of Community-Engagement Waivers
As explained in the “Courts” section above, a federal district court recently vacated the approval of the Medicaid waivers granted to Kentucky and Arkansas to establish “community engagement” (a.k.a., work) requirements for Medicaid eligibility. The waiver requests were remanded to the agency for additional review. To date, the Centers for Medicare and Medicaid Services (CMS) has approved such Medicaid Section 1115 waivers in six other states – Arizona, Indiana, New Hampshire, Michigan, Utah (recently granted), and Wisconsin. Applications from a number of other states are still pending.

New Guidance to States For Section 1115 Waiver Proposals
As explained in blog post from CMS Administrator Seema Verma, CMS has released new guidance and templates for states to use in developing and evaluating policies to be implemented through Medicaid Section 1115 demonstration waivers, including those to implement community-engagement substance-use disorder programs.


  • Approved and pending Medicaid waiver applications can be found on gov.
  • The Kaiser Family Foundation regularly updates its state-by-state §1115 Medicaid Waiver Tracker, and also provides related waiver resources and definitions.

Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2019: Findings from a 50-State Survey (March 27, 2019) from the Kaiser Family Foundation and the Georgetown University Center on Children and Families – provides information about eligibility, enrollment, renewal, and cost sharing in each state and DC.

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With families at the center of health care, all children and youth reach their full potential and health disparities are eliminated.

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Family Voices is a national organization and grassroots network of families and friends of children and youth with special health care needs and disabilities that promotes partnership with families—including those of cultural, linguistic and geographic diversity—in order to improve health care services and policies for children.

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