Just Like Home: Consumer Rights in Medicaid

Source: Eric Carlson, Hannah Weinberger-Divack and Fay Gordon, National Senior Citizens Law Center, Advocate’s Guide, May 2014

The National Senior Citizens Law Center (NSCLC) believes that home and community-based services (HCBS) should be provided as an option to every Medicaid beneficiary (consumer) who needs such services, allowing more seniors and persons with disabilities to live with dignity and independence in their homes. Under Medicaid law, HCBS funding exists to give consumers the ability to receive necessary long-term services and supports (LTSS) without moving into a nursing home or other healthcare institution. The value of the HCBS alternative would be destroyed or diluted if HCBS were provided in institution-like settings.

New federal Medicaid rules for the first time set standards to ensure that Medicaid-funded HCBS are provided in settings that are non-institutional in nature. These standards, which took effect in March 2014, apply to residential settings such as houses, apartments, and residential care facilities like assisted living facilities. The standards also apply to non-residential settings such as adult day care programs.

This guide provides consumers, advocates and other stakeholders with information regarding multiple facets of the new standards, including consumer rights in HCBS, and the guidelines for determining which settings are disqualified from HCBS reimbursement. This guide is based on the federal rules and subsequently issued guidance, and will be updated as further information becomes available….