Chapter 3 includes an analysis of federal administrative requirements for home- and community-based services (HCBS) programs and makes a recommendation to reduce the administrative burden for states and the federal government.
HCBS are designed to allow people with long-term services and supports (LTSS) needs to live in their homes or in a home-like setting in the community. The primary way in which states cover HCBS is through Section 1915(c) waivers.
In MACPAC’s June 2023 report to Congress, we analyzed barriers for beneficiaries trying to access HCBS and the challenges states face in managing HCBS programs. In our interviews with state Medicaid officials and other experts, administrative complexity emerged as a particular challenge.
The chapter describes our key findings on administrative complexity across HCBS authorities, including opportunities to streamline and a discussion of the rationale for our recommendation. It concludes with a recommendation to the Secretary of the U.S. Department of Health and Human Services to increase the renewal period for HCBS programs operating under Section 1915(c) waivers and Section 1915(i) state plan amendments from 5 years to 10 years.
From: March 2025 Report to Congress on Medicaid and CHIP