Overview
Home and Community Based Services (HCBS) Waivers are alternative, state-specific Long Term Services and Supports (LTSS) programs that provide services to eligible individuals in their own homes and communities. These waivers serve populations with complex needs and allow the Center for Medicare and Medicaid Services (CMS) to waive certain requirements that would otherwise apply to the Medicaid program. This gives the state the flexibility to define:
- The target group of Medicaid members to be served, subject to certain requirements.
- The maximum number of participants who may be served in each HCBS waiver program.
- The services available to the waiver target group (in addition to what is already available through MassHealth).
- The income and asset rules that usually apply to eligibility for community Medicaid.
Participants in an HCBS Waiver receive both traditional Medicaid services and the additional services available through the HCBS Waiver in which they are enrolled. Participants work with an operating agency to develop a service Plan of Care (POC) that reflects the waiver and non-waiver services and supports they need to be safely served in their homes and communities. There is a maximum number of participants who can be served by each waiver each year and, in order to be approved for a waiver, states must demonstrate the cost neutrality of each program.
Eligibility Criteria
Applicants must be found clinically and financially eligible. Below are the required criteria for all waiver applicants.
Clinical Eligibility
- Demonstrate the need for a facility level of care (LOC), meaning that they would meet the state’s eligibility requirements for services in an institutional setting.
- Have an ongoing need for, and receive, waiver services at least once a month.
- Be able to be safely served in the community with the available waiver and MassHealth services.
Financial Eligibility
There are special financial eligibility rules for the adult HCBS Waiver applicants:
- Applicant’s income must be less than 300% of the SSI Federal Benefit Rate (the SSI FBR for 2024 is $943, so 300% is $2,829)
- Applicant’s total asset value must be less than $2,000
- Countable asset limit on applicant’s spouse (2024 limit is $154,140)
MassHealth, along with the Executive Office of Elder Affairs (EOEA), Department of Developmental Services (DDS), and Massachusetts Rehabilitation Commission (MRC), work in conjunction to operate the HCBS Waivers.
List of Waivers
Massachusetts operates 10 HCBS waivers:
- Frail Elder Waiver (FEW): This waiver provides frail elders, aged 60 and older, access to the service and supports they need to live successfully in the community.
- Department of Developmental Services Adult ID Waivers: These waivers provide services and supports to adults with intellectual disabilities so that they can live in their communities. The three Adult ID Waivers are
- Adult Supports (DDS-AS)
- Community Living (DDS-CL)
- Intensive Supports (DDS-IS)
- Children’s Autism Spectrum Disorder Waiver: This waiver provides in-home services and supports to children birth through age 9 with an Autism Spectrum Disorder.
- Acquired Brain Injury with Residential Habilitation Waiver (ABI-RH) & Acquired Brain Injury Non-Residential Habilitation Waiver (ABI-N): These two waivers are designed to help individuals with an acquired brain injury move from a nursing facility or chronic disease, rehabilitation, or psychiatric hospital back into their communities.
- ABI–Residential Habilitation (ABI-RH) – for individuals who need supervision and staffing 24 hours a day, seven days a week in a provider-operated residence.
- ABI–Non-residential Habilitation (ABI-N) – for individuals who can move to their own home or apartment or to the home of someone else and receive services in the community.
- Moving Forward Plan Community Living Waiver (MFP-CL) & Moving Forward Plan Residential Supports Waiver (MFP-RS): These two waivers are designed to help individuals moving from a nursing facility or chronic disease, rehabilitation, or psychiatric hospital back into their communities.
- MFP Residential Supports (MFP-RS) – for individuals who need supervision and staffing 24 hours a day, seven days a week in a provider-operated residence.
- MFP Community Living (MFP-CL) – for individuals who can move to their own home or apartment or to the home of someone else and receive services in the community.
- Traumatic Brain Injury Waiver (TBI): This waiver helps individuals who have traumatic brain injuries who want to live in their communities.
Please see the table below for a summary of available waivers, their operating agencies, and the populations they service.
| Waiver | Operating Agency | Target Population |
|---|---|---|
| Frail Elder (FEW) | EOEA | Adults age 60 and older |
| Adult Supports (AS) | DDS | Adults with intellectual disabilities age 22 and older |
| Community Living (CL) | DDS | Adults with intellectual disabilities age 22 and older |
| Intensive Supports (IS) | DDS | Adults with intellectual disabilities age 22 and older |
| Children’s Autism Spectrum Disorder | DDS | Children with Autism Spectrum Disorder (through age 9) |
| Acquired Brain Injury Non-Residential Habilitation (ABI-N) | MRC | Adults with ABI sustained at age 22 and older |
| Acquired Brain Injury with Residential Habilitation (ABI-RH) | DDS | Adults with ABI sustained at age 22 and older |
| Moving Forward Plan Community Living (MFP-CL) | MRC | Adults who are disabled or seniors age 18 and older |
| Moving Forward Plan Residential Supports (MFP-RS) | DDS | Adults who are disabled or seniors age 18 and older |
| Traumatic Brain Injury (TBI) | MRC | Adults with TBI age 18 and older |
Additional Resources
For further information about HCBS Waivers, including specific eligibility criteria, services offered, service delivery options, and application materials, please see the links below.
Adult ID Waivers: Includes the Adult Supports (AS), Community Living (CL), and Intensive Supports (IS) Waivers.
Children’s Autism Spectrum Disorder Waiver
Traumatic Brain Injury Waiver (TBI)
HCBS waivers are typically up for renewal and re-approval every five years. If you are interested in learning more about the public comment input process for HCBS renewal and amendment applications, please follow this link.
The CMS Home and Community Based Services Settings Community Rule ensures that HCBS waiver participants have access to the benefits of community living, and that they live and receive services in integrated, non-institutional settings. To get more information on the HCBS Settings Community Rule, the federally approved Statewide Transition Plan (STP), or the Community Rule Grievance Process, please follow this link.
The Money Follows the Person (MFP) Demonstration helps older adults and people with disabilities move from facility-based care back to the community by connecting them with home- and community-based services. If you are interested in learning more about the MFP Demonstration, please follow this link.
States develop and operate HCBS waivers following federal guidelines from CMS. To learn more about the federal rules governing these waivers, please follow this link. If you are interested in learning more about waivers that operate in other states, please follow this link.
The MassHealth HCBS Team, MRC, and DDS jointly operate the ABI/MFP/TBI Waiver Stakeholder Advisory Committee, which includes waiver participants, families, providers, advocates, and state agency staff. The committee's mission is to ensure the highest quality services by analyzing data and incorporating diverse perspectives. If you are interested in learning more or joining the stakeholder committee, please follow this link.
Contact for Home and Community Based Services (HCBS) Waivers
Online
| Date published: | October 11, 2023 |
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| Last updated: | September 24, 2024 |