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​Almost 1 in 6 residents relies on Medicaid to pay for daily services (15.0%). State Medicaid programs can cover home and community-based services (HCBS) such as personal care and supportive services provided in assisted living communities. Medicaid does not pay for room and board costs.

States can use several different Medicaid authorities to cover such services in assisted living:

  • Medicaid state plan authorities,
  • § 1915(c) HCBS waiver,
  • concurrent § 1915(b) managed care waiver, or
  • §1115 research or demonstration programs.

Note, a small minority of state Medicaid programs do not cover services in assisted living. 


 Why Medicaid Matters


 Home and Community-Based Setting Rule (HCBS Rule)


​In 2014, the Centers for Medicare and Medicaid Services (CMS) issued a final rule establishing requirements for the qualities of settings that are eligible for Medicaid HCBS waiver reimbursement.

On May 9, 2017, CMS issued an informational bulletin announcing an extension of the transition period for compliance with the HCBS Setting Rule to March 17, 2022.

HCBS Rule Overview
NCAL Policy Briefs