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Medicaid Waivers

Home and Community Based Settings (HCBS) Rule

Home and Community Based Services Settings Rule and Montana's Statewide Transition Plan Powerpoint - December 2022
Home and Community Based Services Transition Plan
Home and Community Based Settings Remediation Plans Webex PowerPoints - August 2016

Montana DDP Medicaid Waivers

Overview

At one time, only a small portion of Medicaid long-term care spending for disabled individuals was directed to home and community services. Now, some services and benefits may be offered through the Montana Medicaid State Plan or through home and community-based services (HCBS) waiver programs.

The Centers for Medicare/Medicaid Services, a program of the US Department of Health and Human Services, allows Montana and other states to operate several HCBS waiver programs at once, each offering a distinct package of services and supports to a different group of individuals. These choices combine to give states considerable latitude in deciding which services and supports will be offered and in customizing benefit packages to meet the needs of particular groups. Medicaid home and community services are available to beneficiaries of all ages with many different types of physical and mental disabilities and chronic illnesses.

Because of the way Medicaid was originally designed and has been amended over time, distinct programs were developed to provide services to certain categorical populations, most notably women with dependent children. In the long-term care context, covered categories include the “aged, blind, and disabled.” These three populations account for the majority of Medicaid long-term care spending on home and community services, primarily through the personal care option, the HCBS waiver program, and the home health benefit. The “aged and disabled” categories taken together include people of all ages who have physical or mental disabilities, including serious mental illness, mental retardation, and other developmental disabilities. (From Understanding Medicaid Home and Community Services: A Primer by Gary Smith)

There are several different types of waivers in the Medicaid statute. Title XIX permits the Secretary of Health and Human Services to waive certain provisions required under the regular Medicaid State plan: Comparability (amount, duration, and scope); Statewideness; Income and resource requirements; and Freedom of Choice of all willing and qualified providers.

Section 1915(c) of the Act allows States to provide home and community based services to people who would otherwise require institutional care and is the major tool for meeting rising demand for long-term services and supports.

Montana currently administers one Medicaid Waiver program which is a 1915(c) waiver: the Comprehensive Waiver (0208).