Home and Community Based Services (HCBS) Waiver Programs

Proposed Waiver Ammendments

In accordance with legislation passed in the 2023 General Session, the Utah Department of Health and Human Services will be amending 6 home and community-based services waiver programs. Requirements in house bill 290 will be completed for the Medically Complex Children’s Waiver and caregiver compensation requirements from senate bill 106 will be added to the Community Supports, Community Transitions, Limited Supports, Physical Disabilities, and Acquired Brain Injury Waivers.

American Rescue Plan Act (ARPA) changes will also be made to waivers where reimbursement has increased during the public health emergency and need to be continued through the rest of the Federal authorization period. Several of the waivers listed above, as well as the New Choices and Aging Waivers will have these provider payment increases continued.

State Implementation Plans for each waiver can be viewed here:

An overview of the changes can be found in this Executive Summary: Word Doc | PDF opens in a new tab

Public Comments will be accepted through August 27th, 2023 in the following ways:

Mail: Utah Department of Health and Human Services
     Division of Integrated Healthcare
     Attn: HCBS Waiver Public Comments
     PO BOX 143112
     Salt Lake City, UT 84114-3112

General Information

Utah Has Nine Medicaid 1915(c) HCBS Waivers:

  • Acquired Brain Injury Waiver
  • Aging Waiver (For Individuals Age 65 or Older)
  • Community Supports Waiver for Individuals with Intellectual Disabilities or Other Related Conditions
  • Medicaid Autism Waiver
  • Medically Complex Children’s Waiver
  • New Choices Waiver
  • Physical Disabilities Waiver
  • Waiver for Technology Dependent Children
  • Limited Supports Waiver

What is a Medicaid Waiver?

  • In 1981, Congress passed legislation allowing states greater flexibility in providing services to people living in community settings.
  • This legislation, Section 1915(c) of the Social Security Act, authorized the “waiver” of certain Medicaid statutory requirements.
  • The waiving of these mandatory statutory requirements allowed for the development of joint federal and state funded programs called Medicaid 1915(c) Home and Community Based Services Waivers.

How does the 1915(c) HCBS Waiver work?

  • The Utah Department of Health, Division of Health Care Financing (HCF – Medicaid) has a contract with the Centers for Medicare and Medicaid Services (CMS – the federal Medicaid regulating agency) that allows the state to have a Medicaid 1915(c) HCBS Waiver.
  • The State Implementation Plan defines exactly how each waiver program will be operated.
  • All State Implementation Plans include assurances that promote the health and welfare of waiver recipients and insure financial accountability.
  • The contract is called the State Implementation Plan and there is a separate plan for each waiver program.

What are the Characteristics of a Waiver?

  • States may develop programs that provide home and community based services to a limited, targeted group of individuals (example: people with brain injuries, people with physical disabilities, or people over age 65) or in the community has to be the same or less than if they lived in a nursing facility.
  • Services provided cannot duplicate services provided by Medicaid under the Medicaid State Plan.
  • States must provide assurances to the Center for Medicare & Medicaid Services (CMS) that necessary safeguards are taken to protect the health and welfare of the recipients of a waiver program.
  • Individuals may participate in a waiver only if they require the level of care provided in a hospital nursing facility (NF) or an intermediate care facility for people with intellectual disabilities (ICF/ID).
  • States are required to maintain cost neutrality which means the cost of providing services to people at home.