Home and Community Based Services (HCBS)

Medicaid home and community-based services provide opportunities for people to receive long-term services and supports in their own home or community, rather than in an institution or isolated setting.

HCBS Funding in the American Rescue Plan Act


The American Rescue Plan Act (ARPA) of 2021 was signed into law on March 11, 2021. Section 9817 of ARPA provides states with a temporary ten (10) percentage point increase to the federal medical assistance percentage (FMAP) for Medicaid HCBS, if certain federal requirements are met. States must use funds equal to the amount of federal funds attributable to the increased FMAP to implement activities that enhance or strengthen Medicaid HCBS. HHSC submitted an initial spending plan to the Centers for Medicare and Medicaid Services (CMS) on July 12, 2021.

On August 19, 2021 CMS responded to HHSC’s initial submission with partial approval and requests for clarification about specific activities in the plan. Read CMS’s letter to HHSC (PDF).

HHSC met with CMS in September to get answers to HHSC’s outstanding questions. On September 21, 2021 HHSC responded to CMS’s questions and documented a summary of the information provided by CMS. HHSC also updated the spending plan and narrative to reflect the clarification CMS asked for. A copy of HHSC’s response can be found here (PDF).

Quarterly Updates

States are required to provide updates to CMS about their spending plans and highlight any changes from their original plan. HHSC submitted its first quarterly update on October 26, 2021. Read the update here (PDF).

Stakeholder Communication

Sign up to receive updates about the HCBS spending planning.

On July 15, 2021, HHSC held a webinar to update stakeholders about HHSC’s submission:

When another webinar is scheduled, we will post the information here.

Email Medicaid HCSB Rule with questions.


HHSC is waiting for full federal and state approval before spending any of the money described in the plan.

HCBS Settings Regulations

Public Comment Period for Heightened Scrutiny Settings List

HHSC will submit a list of Medicaid HCBS settings to CMS for heightened scrutiny review as required by the Centers for Medicare and Medicaid Services (CMS) Home and Community Based Services Rule at 42 CFR 441.201(c)(5)(v) (“HCBS Final Rule)”. HHSC plans to submit all assisted living facilities participating in the STAR+PLUS HCBS program for heightened scrutiny review.

HHSC invites members of the public, including people receiving HCBS and their families, providers and other stakeholders to submit comments on the list of settings identified for heightened scrutiny review. The public comment period will end October 24, 2021.

The list of settings and instructions for submitting public comments can be found in the Heightened Scrutiny (PDF).


In March 2014, the Centers for Medicare and Medicaid Services (CMS) issued federal regulations that added requirements for settings where Medicaid HCBS are provided. The regulations require that a Medicaid HCBS setting be selected by the person and have other qualities based on the person’s needs indicated in a person-centered service plan.

CMS has given states until March 17, 2023 to bring Medicaid programs into compliance with the regulations.

The purpose of the regulations is to ensure people receive Medicaid HCBS in settings that are integrated in the community. A Medicaid HCBS setting must facilitate a person’s choice regarding services and supports and who provides them.

Medicaid HCBS settings must also be integrated in and support full access to the greater community, including opportunities to:

  • Seek employment and work in competitive, integrated settings;
  • Engage in community life;
  • Control personal resources; and
  • Receive services in the community.

The HCBS settings regulations apply to the following Texas Medicaid programs and services:

  • Community Living Assistance and Support Services (CLASS)
  • Deaf-Blind with Multiple Disabilities (DBMD)
  • Home and Community-based Services (HCS)
  • Texas Home Living (TxHmL)
  • Medically Dependent Children's Program (MDCP)
  • Youth Empowerment Services (YES)
  • Community First Choice (CFC) services
  • HCBS Adult Mental Health (HCBS AMH)

Statewide Transition Plan

CMS requires states to submit a transition plan describing their planned initiatives and activities to achieve compliance with the federal HCBS settings regulations. The transition plan must include:

  • An assessment of settings where Medicaid HCBS are provided
  • Remediation strategies for settings that do not meet the requirements of the regulations
  • A summary of public and stakeholder input on the assessment processes and remediation strategies
  • A summary of public comments received on the transition plan and any revisions made to the plan in response to public comment

Texas submitted its initial transition plan to CMS and has amended it based on responses from CMS. The initial plan and amended versions are available at the following links:

Heightened Scrutiny

CMS requires states to submit evidence of how Medicaid HCBS settings that CMS presumes have institutional or isolating qualities have overcome that presumption. These settings must go through a heightened scrutiny review by CMS.

CMS presumes that the following types of settings have institutional or isolating qualities:

  • Prong 1 settings: Located in a hospital, nursing facility, intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID) or institution for mental disease (IMD).
  • Prong 2 settings: Located adjacent to a public hospital, nursing facility, ICF/IID or IMD.
  • Prong 3 settings: Have the effect of isolating people from the broader community of people who do not receive HCBS.

CMS requires states to identify settings that meet the criteria above and submit to CMS a list of settings that the state believes can overcome the institutional or isolating presumption. The list must include:

  • The prong that each setting falls into for heightened scrutiny
  • A summary of how each setting has or will overcome the institutional or isolating presumption and
  • The state’s plan for remediation to ensure compliance with the regulations by March 17, 2023.

CMS will use the list provided by the state to compile a random sample of settings to go through heightened scrutiny review. The list of settings and instructions for submitting public comments can be found in the Heightened Scrutiny (PDF).

Policy Guidance

CMS Resources

HHSC Webinars


Please click here for Provider Communications.

Email questions to Medicaid HCBS.

Information & Provider Letters

Case-sensitive. Use commas to separate multiple entries.
Note: These files are in PDF format unless otherwise noted.
Number Title/Notes Date Published
PL 2017-24 All Providers are Required to Redo Nurse Aide Registry (NAR) Searches Conducted from June 14, 2017, through August 3, 2017
PL 2017-23 All Providers Are Required To Redo Employee Misconduct Registry (EMR) Searches Conducted From June 9, 2017, through July 27, 2017