Amputee Coalition Fact Sheet

Home and Community-Based Services

Web Development Fact Sheet

Created 08/2021

What are Home and Community-Based Services?

Home and Community-Based Services (HCBS) are types of person-centered care delivered in the home and in the community. HCBS programs address the needs of people with functional limitations who need assistance with everyday activities, like getting dressed or bathing. HCBS are often designed to enable people to stay in their homes rather than moving to a facility for care.1These programs are available for a variety of populations, such as older adults and people with disabilities and/or severe mental illnesses.2 Eligibility for and services provided by HCBS vary from state to state and usually are run by your state’s Medicaid program.1

Types of HCBS

Home and Community-Based Services generally fall under two categories: health services and human services. Health Services meet medical needs while Human Services support daily living.1

Health Services

  • Home health care, such as:
    • Skilled nursing care
    • Therapies: occupational, speech, and physical
    • Dietary management by a registered dietician
    • Pharmacy
  • Durable medical equipment (DME)
  • Case management
  • Personal care
  • Caregiver and client training
  • Health promotion and disease prevention
  • Hospice care

Human Services

  • Senior centers
  • Adult daycares
  • Congregate meal sites
  • Home-delivered meal programs
  • Personal care (dressing, bathing, toileting, eating, transferring to or from a bed or chair, etc.)
  • Transportation
  • Home repairs and modifications
  • Home safety assessments
  • Homemaker and chore services
  • Information and referral services
  • Financial services
  • Legal services, such as help preparing a will
  • Telephone support

HCBS programs may offer a combination of both types of services but do not necessarily offer all services from both categories.

Who is eligible for HCBS?

Nearly all states and Washington, D.C. offer home and community-based services through Medicaid, which are called “HCBS waivers.” The term was coined because an agreement to “waive” a Medicaid requirement must be reached to allow the state to provide certain services outside of an institutional setting .3 States create HCBS programs to target specific populations, and eligibility for the programs vary from state to state. Generally, states will offer HCBS waivers to elderly individuals (aged 65 and over), those with physical disabilities, adults and children with developmental disabilities, and medically fragile individuals who require life support or other extensive medical equipment.4

However, not everyone within these groups is automatically eligible for the HCBS waiver programs; they must also require a certain level of care. Since these waiver programs were created specifically to keep people in their own homes and communities instead of receiving institutional care, an individual needs to meet medical criteria that would require care in a nursing home if they did not receive care in their own home or community.4

There are also financial eligibility requirements for these programs. While states don’t have to require that an individual receives Medicaid, most states do. There are limits on how much income someone can earn or receive as well as financial resource caps (savings, checking, stocks, bonds, etc.)4

Where can I apply?

Since eligibility requirements differ from state to state, the first step is to apply for Medicaid in your state. You can do this either through your state’s Medicaid office or through the Health Insurance Marketplace. If you apply through the Health Insurance Marketplace and are eligible for Medicaid, the marketplace will send your information to your state’s Medicaid agency and an agent will contact you to navigate you through the application process.4

To apply for a specific HCBS waiver program, contact Centers for Medicare & Medicaid Services to find the agency in your state. An agent in the office will help you with the application process. You will be asked to provide information about your need for services offered by that specific program, which may include detailed physicians’ statements and verification of your income and financial resources. Each state determines the types of HCBS they offer and how many people receive these services, you may need to be prepared to be added to a wait list for services.4

The Coalition supports programs and services that increase the independence and well-being of people living with limb loss and limb difference, including advocating for additional HCBS and resources for state Medicaid programs. More information about expanding access to care can be found on our website.

Additional Resources

AssistedLiving.org
Your Guide to Medicaid Home and Community-Based Services
https://www.assistedliving.org/what-is-a-medicaid-waiver/#who_is_eligible_for_an_hcbs_waiver_program_
(855) 221-9611

Centers for Medicare and Medicaid Services (CMS)
State Resources Map
https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/LTSS-TA-Center/info/state-resources-map

Healthcare.gov
Health Insurance Marketplace
https://www.healthcare.gov/
(800) 318-2596

Medicaid.gov
Home and Community-Based Services
https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c/index.html#:~:text=Nearly%20all%20states%20and%20DC,Waiver%20programs%20are%20active%20nationwide.

Medicaid.gov
State Medicaid Contacts
https://www.medicaid.gov/about-us/contact-us/contact-your-state-questions/index.html

National Association of Area Agencies on Aging
Home and Community-Based Services
https://www.n4a.org/hcbs

National Health Council
The Home and Community-Based Services Access Act
https://nationalhealthcouncil.org/the-home-and-community-based-services-access-act/
(202) 785-3910

References

  1. Roy, M. J., & Francis, J. L. (2011). The psychological recovery of physically wounded service members.
  2. Spiess, K. E., McLemore, A., Zinyemba, P., Ortiz, N., & Meyr, A. J. (2014). Application of the five stages of grief to diabetic limb loss and amputation. The journal of foot and ankle surgery, 53(6), 735-739.
  3. Bradway, J. K., Malone, J. M., Racy, J., Leal, J. M., & Poole, J. (1984). Psychological adaptation to amputation: an overview. Orthotics and prosthetics, 38(3), 46-50.
  4. Singh, R., Hunter, J., & Philip, A. (2007). The rapid resolution of depression and anxiety symptoms after lower limb amputation. Clinical rehabilitation, 21(8), 754-759.
  5. Pomares, G., Coudane, H., Dap, F., & Dautel, G. (2020). Psychological effects of traumatic upper limb amputations. Orthopaedics & Traumatology: Surgery & Research.
  6. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

For print requests, please contact:
Amputee Coalition
601 Pennsylvania Ave, Suite 600, Washington, DC 20004
888/267-5669
amputee-coalition.org.

Suggested AMA format citation for this material:

Amputee Coalition. Home and Community-Based Services Fact Sheet. https://www.amputee-coalition.org/. Published August 2021. Accessed [date].

It is not the intention of the Amputee Coalition to provide specific medical or legal advice but rather to provide consumers with information to better understand their health and healthcare issues. The Amputee Coalition does not endorse any specific treatment, technology, company, service or device. Consumers are urged to consult with their healthcare providers for specific medical advice or before making any purchasing decisions involving their care.

© Amputee Coalition. Local reproduction for use by Amputee Coalition constituents is permitted as long as this copyright information is included. Organizations or individuals wishing to reprint this article in other publications, including other websites must contact the Amputee Coalition for permission to do so, by emailing a request to rc@amputee-coalition.org.