CMS Finalizes Medicaid HCBS Access Rule

Last week, the Centers for Medicare & Medicaid Services published the Ensuring Access to Medicaid Services final rule. This historic regulation includes new requirements, effective July 9, related to the direct care workforce and access to home and community-based services.   

Last summer, USAging submitted a response to the proposed rule, overall applauding CMS for their efforts on improving access to Medicaid HCBS and providing feedback on proposed changes. Major provisions in the final rule include CMS requiring at least 80 percent of all Medicaid payments for specific types of HCBS be spent on compensation for direct care workers, states reporting annually on the percentage of payments spent on that compensation, and states reporting on HCBS waiting lists.  

Because the Access Rule requires states to make significant changes to their Medicaid programs, CMS is giving them up to six years to implement the new provisions. ACL will continue working with CMS to ensure the Aging Network is involved in discussions; to stay up to date with all resources and stakeholder calls, visit Access to Care | Medicaid

USAging will share a full Legislative Update on this rule in the next week, but if you have any questions, please contact the policy team at  



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