Home and Community-Based Services

The majority of individuals who need long-term services and supports (LTSS) in the United States rely on unpaid assistance from family and friends. The economic value of the unpaid care they provide is estimated to be over $470 billion annually. Unmet needs and waiting lists for Medicaid Home and Community Based Services (HCBS) place significant strain on individuals with disabilities and their families. This report explores how increasing access to HCBS services can reduce out-of-pocket costs for families and strengthen employment and financial wellbeing of family caregivers.

Includes archives of prior webinars on HCBS Quality efforts.

The Administration for Community Living (ACL), joined the Department of Health and Human Services (HHS) Office of Inspector General (OIG) and the HHS Office of Civil Rights to produce a report on ensuring beneficiary health and safety in group homes through state implementation of comprehensive compliance oversight. This report serves as a resource for states to use as a part of efforts to ensure that all group homes are safe and healthy places for people with disabilities.

The Government Accountability Office (GAO) examined states’ needs assessment processes for provision of long-term services and supports. GAO studied six states that differed in the following ways: assessment tools in use, participation in federal initiatives, HCBS delivery systems, and geographic location. GAO also reviewed federal requirements and documents and interviewed CMS officials and stakeholders.

This guide is designed to provide elder law attorneys with a better understanding of the HCBS Settings Rule and how they can advocate for a strong, effective system that achieves the spirit and intent of the rule. The guide includes an overview of the rule, a process for states to comply with the HCBS Rule, opportunities for advocacy to promote your clients' best interests, and a review of special issues including dementia care and evictions.