Home & Community Based Services

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

HCBS Settings Regulations

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 purpose of the regulations is to ensure people receive Medicaid HCBS in settings that are integrated in the community.

Medicaid HCBS settings must 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)
  • STAR+PLUS HCBS
  • Community First Choice (CFC) services
  • HCBS Adult Mental Health (HCBS AMH)

Statewide Transition Plan

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

Read HHSC’s statewide transition plan on the HCBS provider page.

Heightened Scrutiny

Heightened scrutiny is a review process required by CMS for settings that are presumed to have institutional or isolating qualities. The purpose of heightened scrutiny is to determine:

  • If a setting that appears institutional or isolating is actually home and community-based and
  • If a setting that has isolating or institutional characteristics can become home and community-based.

More information about the heightened scrutiny process is available at this link.

Resources