Is Your Home or Supports at Risk?

Medicaid is currently enforcing new regulations and guidance that may restrict waiver funding from being used in specific homes, workplaces, and day program settings. If you or your loved one uses Medicaid funding to access support services in any of the following settings, access to your support services may be at risk if the state or federal government determine it is isolating or institutional in nature:

  • Gated/secured “community” for people with disabilities
  • Farmstead or disability-specific farm communities
  • Residential schools
  • Intentional communities
  • Facility-based day programs
  • Facility-based work opportunities
  • Campus setting or property where multiple programs are co-located and operated by the same service provider

These settings have been identified by Medicaid officials as having the effect of isolating citizens with disabilities. Therefore, advocates must convince Medicaid officials that these settings are not isolating or institutional, but are your or your loved one’s preferred setting choice.

There are several opportunities for you to influence the determination if your setting may or may not be “home and community-based” enough to receive Medicaid waiver funding:

  1. Make sure you have a documented Person-Centered Plan that meets the new HCBS Person-Centered Planning criteria. Find more information on our Person-Centered Planning page.
  2. Public Comment- Every state must create a State Transition Plan (STP) to be approved by CMS. In the STP, your state had to create a timeline toward compliance of these new regulations. This timeline should have indicated when settings would be assessed and what settings may go under “heightened scrutiny” for being isolating or institutional. If the setting is put through the “heightened scrutiny” process, there will be a time when public comment is sought. THIS IS YOUR CHANCE to share why this setting is your preferred setting from other options and reasons why it is not isolating or institutional in nature. Find the latest version of your STP here.
  3. It may seem intimidating at first, but calling and scheduling to meet with policymakers in your state is essential for ensuring that your home and community options are not limited. They can influence your state’s Medicaid authority, and thus need to know if your state Medicaid officials are limiting a home or community choice you need. Share the federal HCBS requirements and tell them if you believe your state may be trying to implement more stringent criteria than what is required at the federal level. Your story is most powerful, but feel free to use CCC Materials or offer your state’s statistics as well.

To locate your Member of Congress on-line go to:

  • U.S. House of Representatives: http://www.house.gov
  • U.S. Senate: http://www.senate.gov
  • You can also get the phone number for your Member of Congress using the US Capitol Switchboard: (202) 224-3121
  • The White House website also has a form where you can send the President a message: http://www.whitehouse.gov/