Capitol Correspondence - 12.19.23

KFF Brief Sheds Light on States’ Progress in Implementing Settings Rule

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The Kaiser Family Foundation (KFF) has released a comprehensive brief detailing the progress and challenges faced by states in implementing the Medicaid Home and Community Based Services (HCBS) Settings Rule, officially enforced in March 2023, nearly a decade after its initial publication in January 2014.

The HCBS Settings Rule is aimed at transforming how HCBS are delivered to the approximately four million people relying on Medicaid HCBS. In KFF’s most recent survey, the findings include use of corrective action plans (CAPs) was most common for waivers serving people with intellectual or developmental disabilities, those aged 65 and older, or individuals with physical disabilities. Among the 45 states with waivers for intellectual or developmental disabilities, 29 had CAPs, while 23 out of 43 states with waivers for those aged 65 and older or with physical disabilities had CAPs.


Additionally, states continue to grapple with determining compliance for all HCBS providers and address workforce challenges that pose a threat to HCBS access. Timelines for full implementation extend from July 2023 to January 2026, reflecting the multifaceted nature of challenges encountered on the ground.