Home and Community Based Services (HCBS)

Significant efforts are underway at both the state and national levels to "rebalance" the long-term care system to give consumers needing long-term care services more choices in where and how they receive those services. "CHOICES," "Money Follows the Person," "Nursing Home Transition and Diversion" are some of the terms being used and programs developed to give consumers more choice to explore community options. Here you will find information about these different programs, including Aging and Disability Resource Centers (ADRC's) which are single points of entry to long-term care services being developed around the country.

See our MDS 3.0 page for related information.

Long-Term Care Ombudsman Program & HCBS


Charting the Long-Term Care Ombudsman Program's Role in a Modernized Long-Term Care System
This Long-Term Care Ombudsman Program Strategic Directions Work Group Meeting Report, by the National Ombudsman Resource Center (NORC), prepared by the National Association of State Units on Aging (NASUA), seeks to help long-term care ombudsmen to define their role and develop coordination efforts in a new long-term care system.

Home Care Ombudsman Programs Status Report: 2007
Ombudsman programs in twelve states are authorized or mandated under state law to provide advocacy on behalf of consumers who receive home and community based care. Over the last seven years the Long-Term Care Ombudsman Program's involvement in home care advocacy has changed little; the numbers of complaints, types of individual and systems issues, and the level of support have remained relatively stable. This paper updates and expands information previously collected on home care ombudsman programs in 2000. New information reported here was gathered in April/May 2007 through a web-based questionnaire and a teleconference.

The Role of the Long-Term Care Ombudsman in Home Care Advocacy (June 2001)
This technical assistance paper, prepared by the National Association of State Units on Aging (NASUA), includes information on the scope of Home Care Ombudsman Programs' responsibilities, the types of complaints which may be reported, program funding, access issues, training and systems advocacy activities.

Strategy Brief:  Ombudsman Program Connections to Home- and Community-Based Service (July 2004)
This document presents discussion highlights from a National Dialogue Forum convened by NASUA on the topic. The primary issues discussed by the participants included: the ombudsman program's role in providing information about home care to consumers; consumer access to home care services; advocacy for quality home care options and relationships with the home- and community-based services system.

HCBS Resources


On January 10, 2014 the Centers for Medicare and Medicaid Services (CMS) issued the Medicaid Home and Community-Based Services (HCBS) settings final rule (CMS-2249-P2).  The final regulation addresses several sections of Medicaid law under which states may use federal Medicaid funds to pay for HCBS. The rule establishes requirements for the qualities of settings that are eligible for reimbursement for Medicaid HCBS provided under sections 1915(c), 1915(i), and 1915(k). Click here to read the final rule.

CMS has released several fact sheets on the final rule, which can be viewed here:

Transitions and Long-Term Care: A Look at MDS 3.0 Section Q and Money Follows the Person (January 30, 2012)
The Administration on Aging hosted a webinar giving an overview of MDS 3.0 Section Q and Money Follows the Person and detailing how these programs affect the aging network.

Webinar Materials:

ADRC Technical Resource Center
The ADRC Grant Program, a cooperative effort of the Administration on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS), was developed to assist states in their efforts to create a single, coordinated system of information and access for all persons seeking long term support to minimize confusion, enhance individual choice, and support informed decision-making. The ADRC Technical Assistance Exchange (TAE) provides technical assistance through one-on-one support, semi-annual ADRC national meetings, weekly newsletters, monthly webcasts and a variety of other ways.

Money Follows the Person ToolKit
Developed by the Rutgers Center for State Health Policy, National Academy for State Health Policy and the NCB Development Corporation in 2006, this toolkit compiles information from numerous sources about nurisng home transition and Money Follows the Person (MFP)  initiatives.

Money Follows the Person: Impediments to Implementation: A Fact Sheet on Program Start up, Capacity and Access
Developed by NASUAD. The Money Follows the Person Rebalancing Demonstration Program (MFP) was designed to assist states in rebalancing their long-term care systems, and to help Medicaid beneficiaries transition from institutions to the community. Since its inception, MFP has faced many barriers to implementation, most of which have resulted in the program transitioning fewer individuals than originally anticipated. In efforts to clarify the origin and impact of these early problems and ongoing capacity and access challenges, NASUAD prepared a fact sheet, outlining some of the most commonly-reported programmatic complications, such as the unanticipated consequences of statutory compliance and a lack of accessible, affordable housing for MFP participants.

Nursing Facility Transition: A Resource Kit for Long-Term Care Ombudsman
This resource kit provides information and materials for ombudsman programs about nursing facility transition. It is designed to provide state ombudsmen with an easy to use reference point for basic information about state and federal nursing facility diversion and transition initiatives and to facilitate exploration of ombudsman program roles in helping residents who wish to leave the nursing facility.

Resources to Share with Consumers


Piecing Together Quality Long-Term Care - A Consumer's Guide to Choices and Advocacy
This guide from the National Consumer Voice for Quality Long-Term Care (the Consumer Voice) and accompanying fact sheets are designed for advocates and consumers who are currently receiving or who may in the future receive long-term services and supports in the community.  The purpose of these materials is to inform advocates and consumers about options for long-term services and supports, and to empower consumers - through education - to effectively advocate on their own behalf.

Department of Justice ADA Mediation Program
In enacting the ADA, Congress specifically encouraged the use of alternative means of dispute resolution, including mediation, to resolve ADA disputes. Through its ADA Mediation Program, the Department refers appropriate ADA disputes to mediators at no cost to the parties. The mediators in the Department of Justice program are professional mediators who have been trained in the legal requirements of the ADA. The Department's program has resolved many ADA disputes quickly and effectively.

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