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New Toolkit to Help Advocates Push for Strong HCBS Rules

Justice in Aging, together with other disability and aging advocacy groups, issued a toolkit to help advocates push for strong implementation of the new Home and Community Based Services (HCBS) Settings Rules in their states. The new HCBS Settings Rules require all settings funded by Medicaid HCBS programs to, among other things, provide opportunities for participants to be integrated in and engage in community life, have access to the community, control their personal resources, and seek employment and work in competitive settings. States have until March 2019 to transition their HCBS programs into full compliance with the new settings requirements.

This new toolkit provides advocates with detailed information about the HCBS Settings Rule and provides action steps for advocates to impact implementation of the new rules in their states. The toolkit contains six documents:

  1. The Medicaid Home and Community-Based Services Settings Rules:  What You Should Know;
  2. Home and Community-Based Services Regulations Q&A:  Settings Presumed to be Institution & the Heightened Scrutiny Process, and
  3. The Home and Community-Based Settings Rules:  How to Advocate for Truly Integrated Community Settings, as well as an abridged version of this resource.
  4. State Transition Plans for New Medicaid HCBS Regulations: Four Tips for Consumer Advocates
  5. Medicaid’s New Rule to Promote Independence and Choice: What Advocates Need to Know
  6. Applying the New Federal HCBS Rules to Adult Day Centers: What You Can Do

The extent to which these new rules are a catalyst for positive change in states’ service systems will depend on the strength of each state’s transition plan, as well as the ability of stakeholders and advocates to influence the plan and monitor its implementation. All states have already submitted to CMS their initial transition plans, and CMS has provided feedback to states about needed improvements and next steps for amending and implementing their transition plans. The next several months are an important time to become involved because this is when important decisions at the state level will be made and the parameters of state plans will be set. CMS has indicated that they are looking closely at public comments — advocates’ voices matter!

Justice in Aging is pleased to partner with a coalition of disability and aging advocates to develop this toolkit and work together for strong implementation of the HCBS Settings Rule –the American Network of Community Options and Resources, Association of People Supporting Employment First, Association of University Centers on Disabilities, Autistic Self Advocacy Network, Bazelon Center for Mental Health Law, Coalition to Promote Self-Determination, Human Services Research Institute, National Association of Councils on Developmental Disabilities, National Consumer Voice for Quality Long Term Care, National Council on Independent Living, National Disability Rights Network, National Down Syndrome Congress, National Health Law Program, TASH, and The Arc of the United States.

See Justice in Aging’s complete list of resources on HCBS.

To learn more about the HCBS rules, see, a website with up-to-date information about the rules and states’ implementation maintained by several member organizations in the coalition.

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