Medicaid Home and Community-Based Services Waivers

HCBS waivers expand the types of settings in which people can receive comprehensive long-term care under Medicaid.

Under an HCBS waiver, states can use Medicaid funds to provide a broad array of non-medical services (excluding room and board) not otherwise covered by Medicaid, if those services allow recipients to receive care in community and residential settings as an alternative to institutionalization.

(1999), found unnecessary institutionalization to be a violation of the civil right established by the Americans with Disabilities Act of 1990 that service be provided in the least restrictive environment.

This provision along with Centers for Medicare and Medicaid Services guidance on Olmstead compliance led to rapid adoption by the states of the HCBS waiver.

[2] The settings rule is a regulation that seeks to ensure the rights of people with disabilities receiving services through an HCBS waiver.