Chapter 2 focuses on states’ eligibility and enrollment processes for home- and community-based services (HCBS) programs and makes a recommendation for guidance on provisional plans of care.
Medicaid HCBS are designed to allow people with long-term services and supports (LTSS) needs to live in their homes or a home-like setting in the community. While HCBS is an optional Medicaid benefit for states, currently all states choose to cover it. States have a number of ways in which they can expedite Medicaid eligibility determinations and enrollment for individuals whose income is not determined using modified adjusted gross income (MAGI) and who need HCBS.
The chapter focuses on the use of presumptive eligibility and expedited eligibility flexibilities for non-MAGI populations as well as provisional plans of care. It provides background on these topics as well as the findings from our stakeholder interviews, environmental scan, and review of Section 1915(c) HCBS waivers.
The Commission makes a recommendation on improving guidance to how states can use provisional plans of care, including policy and operational considerations, under Section 1915(c), Section 1915(i), Section 1915(k), and Section 1115 of the Social Security Act.
From: March 2025 Report to Congress on Medicaid and CHIP