During this session, staff presented follow-on work from their November 2023 presentation that compared federal requirements across the various Section 1915 authorities that states use to operate home- and community-based services (HCBS) programs. The presentation began with an overview of Section 1915 authorities and the Centers for Medicare & Medicaid Services’ notice of proposed rulemaking on ensuring access to Medicaid services. Staff also presented results from additional interviews with federal officials and policy experts that examined three specific areas: (1) lack of technical guidance for Section 1915(i) state plan amendments (SPAs); (2) the resource intensive renewal process for Section 1915(c) waivers and Section 1915(i) SPAs; and (3) the cost neutrality requirement for Section 1915(c) waivers.
During this session, staff presented policy options to address these areas and solicited feedback from Commissioners.