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Volume 13 Number 62 News: Medicaid Thousands more Medicaid beneficiaries would be eligible to receive care in their own homes and communities, rather than in institutions, under a proposed rule published March 31 by the Centers for Medicare & Medicaid Services. The proposed rule provides states with guidelines for implementing a provision of the Deficit Reduction Act of 2005 (DRA) that allows states to provide home and community-based services (HCBS) to Medicaid beneficiaries without applying for a waiver, according to CMS. The rule would allow each state to determine its eligibility or needs-based criteria for HCBS, provided recipients have incomes less than 150 percent of the federal poverty level, or $15,600 per person in 2008. The DRA provision eliminated a requirement that beneficiaries be in imminent risk of institutionalization in order to qualify for HCBS. "We anticipate states will be eager to take advantage of this new flexibility," Kerry Weems, CMS acting administrator, said in a statement. "The home and community-based services option is a win/win opportunity, giving beneficiaries more control over their care and allowing states to spend Medicaid resources more efficiently." While states would no longer have to apply for a waiver under the proposed rule, they would be required to submit, and have CMS approve, a state plan amendment. Once approved, the plan does not have to be renewed, CMS said. The proposed rule would emphasize "person-centered" care, which gives individuals an active role in developing their care plans, according to CMS. It also would emphasize "self-directed" care, which allows individuals to manage services such as case management, homemaker, home health aide, personal care, adult day health, habilitation, and respite care. Under DRA, the HCBS option became available in January 2007, and Iowa has already been granted an amendment to their state plan, CMS said. Colorado, Nevada, and Georgia have applications currently under CMS review. The proposed rule is scheduled for publication in the Federal Register on April 4. The proposed rule is available.
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