Home and community-based services (HCBS)

Home and community-based services (HCBS) are Medicaid services that let people receive long-term care in their own homes or communities, rather than in an institution. Medicaid.gov describes them as serving groups such as older adults, people with intellectual, developmental or physical disabilities, and people with mental health or substance use disorders.

Why it matters

In 2021, 63.2 percent of Medicaid spending on long-term services and supports went to HCBS, according to Medicaid.gov. States offer HCBS through several authorities: 1915(c) waivers, 1915(i) state plan HCBS, 1915(j) self-directed personal assistance and 1915(k) Community First Choice (Medicaid.gov), plus section 1115 demonstrations. A state can also cover personal care in its regular Medicaid plan.

Standard waiver services include case management, homemaker services, home health aide, personal care, adult day health, habilitation and respite care (42 CFR 440.180).

To bill HCBS, an agency enrolls as a Medicaid provider, delivers what the client’s person-centered service plan and authorization allow, and records in-home personal care visits with EVV.

Example: a waiver client authorized for 20 hours a week of personal care gets those hours from your caregivers, and your agency bills Medicaid or a managed care plan.

Related: what a Medicaid waiver is and who pays whom, 1915(c) waiver, self-direction.