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New Medicaid Regulation Will Dramatically Affect Waiver Programs

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On January 10, 2014, the Center for and Medicare and Medicaid Services issued a new regulation that will change how home and community based services are delivered by the Medicaid program. The changes put more control in the hands of the recipient of the services, allowing what is called “person-centered” planning. The regulation applies to the various home and community based Medicaid programs run by Pennsylvania, including the Aging Waiver Program for adults over age 60.

Some of the changes include:

  • Requirements that the recipient of the services can direct the plan of care, including choice of the caregiver.
  • Description of the environments where you can receive home and community based services.  This change may affect the right to receive Waiver services in environments such as personal care homes and assisted living facilities in Pennsylvania.
  • The ability of states to combine coverage of Waiver programs to target groups of a population based on need rather than a specific diagnosis.  This may open the door to more services to individuals that don’t current fit in the restricted definitions of the Waiver Programs.  It may also allow the states to access more funds from the Federal government to provide home and community based services.

States will have a year to make the changes to the Waiver Programs.  There will also be a public comment period.  Read the regulation here.

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