Home and community-based services, or HCBS, support people who need assistance while living in community settings. In Medicaid, HCBS is an umbrella term covering several program authorities and state arrangements.
CMS lists options including section 1915(c) waivers, section 1915(i) state-plan services, self-directed personal assistance under section 1915(j), and Community First Choice under section 1915(k). These should not be treated as one interchangeable national benefit.
Identify the actual program
Start with the state, program name and agency responsible for the application or current service. Ask which eligibility process applies and whether the person is requesting a new service, changing an existing plan or transferring between arrangements.
For section 1915(c) waivers, states can target particular populations, define covered services and set the maximum number of people served. Eligibility includes the state's applicable institutional level-of-care requirement. Those features belong to this waiver authority and should not be generalized to every HCBS option.
A diagnosis or the word “Medicaid” on a record does not answer all of these questions.
Distinguish the approved plan from delivery
A service may appear in a proposed plan before a provider, schedule or start date is confirmed. Keep those stages separate.
Ask who will provide the support, which activities are included, how often it is expected and whom the person contacts if a visit does not occur. Clarify the response to a change in need or an interruption in the arrangement.
In a fictional discharge discussion, a family says, “The application is submitted, so someone will come Monday.” The nurse should confirm whether a service has actually been authorized and scheduled, and return the unresolved gap to the planning team. Do not build a care plan on an assumed start date.
Keep the person involved
For 1915(c) waivers, CMS requires services to follow an individualized, person-centered plan. The available service categories can include personal care, homemaker assistance, respite and other supports, depending on the state program.
Ask what the person wants the support to make possible. Consider preferences about the schedule, provider and people involved in planning. Record disagreement or concerns clearly so they can be addressed through the program's process.
Avoid describing another person's availability as a confirmed resource until the responsibility has been discussed and accepted.
Connect nursing information with the service plan
Provide the relevant functional and care information through the approved communication route. Explain changes that may affect the existing arrangement, and identify who will assess or authorize any revision.
Before a transition, confirm how the receiving service obtains instructions and how it reports concerns back. Keep a contact for unresolved access or eligibility questions alongside the clinical follow-up contact.
When services come from several agencies, plan how the care plan will follow the person.
Related pages cover long-term services and supports, disability-inclusive care coordination and home health referrals.
Sources
- Home & Community Based Services Authorities (accessed 2026-09-17) — Medicaid.gov.
- Home & Community-Based Services 1915(c) (accessed 2026-09-17) — Medicaid.gov.