What are home and community-based services?

Home and community-based services (HCBS) offer support and resources that enable people living with disabilities to live in their homes and communities, rather than nursing homes. HCBS are long-term services that support daily tasks like getting dressed or making meals.

The primary funding source for HCBS is Medicaid. Medicaid is a program administered by the states and jointly financed by states and the federal government. States can provide HCBS through several mechanisms in Medicaid, including waivers and other options. All states offer some kind of HCBS, but the rules are different in each state.

In Medicaid, nursing home care is available to everyone who qualifies. However, home and community-based services are not available to everyone. They have different rules and eligibility criteria, and often have waiting lists for services.

Few people are able to privately pay for their attendant needs, so most rely on Medicaid. However, Medicaid has strict income and asset limits that make it hard to save for the future.

Recent action

The Affordable Care Act included several provisions to expand home and community-based services offered through state Medicaid programs.

For example, the Community First Choice Option will provide comprehensive home and community-based attendant services and support for people who are eligible for an institutional level of care. However, only five states have taken up the option so far. To see where your state stands, see this table from the Kaiser Family Foundation.

In 2014, the Centers for Medicare and Medicaid Services issued new rules about the appropriate settings for HCBS, encouraging more community integration.

What's next?

The Reeve Foundation strongly believes that no one should be forced to choose between living at home and receiving the services they need, or remaining in poverty to continue receiving services.

Over the coming years, we will work with the disability community to ensure that HCBS is available in Medicaid and to pursue new policy solutions that allow people with disabilities to access comprehensive, high quality supports in the community without limiting their income or assets.


To learn about the rules and where they stand in your state, visit HCBSadvocacy.org.