This session previewed a draft chapter on Medicaid Section 1915 authorities for home- and community-based services (HCBS) for the March 2025 report to Congress. The chapter includes an analysis of federal administrative requirements and opportunities to reduce administrative burden for states.
Operationalizing HCBS programs can be administratively burdensome for states, and MACPAC has engaged in work over the past two years to identify opportunities to alleviate some of that burden. The chapter begins with background on Medicaid HCBS, the federal authorities under Section 1915 that states use to administer HCBS programs, and the variation in the requirements applicable to them. It then describes our analysis including the purpose of our work and the approach we used. 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.
The chapter 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.
