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Key State Policy Choices About Medicaid Home and Community-Based Services

Appendix Table 1:  State Adoption of Medicaid HCBS by Program Authority, FY 2017
  State Plan Services Waivers
State Home health Personal care Community First Choice Section 1915 (i) Section 1915 (c) Section 1115*
Alabama X X
Alaska X X X
Arizona X X
Arkansas X X X
California X X X X X X
Colorado X X X X
Connecticut X X X X
Delaware X X** X X X
DC X X X X
Florida X X X X
Georgia X X
Hawaii X X X
Idaho X X X X
Illinois X X
Indiana X X X
Iowa X X X
Kansas X X** X
Kentucky X X
Louisiana X X X
Maine X X X
Maryland X X X X X
Massachusetts X X X
Michigan X X X
Minnesota X X X
Mississippi X X X
Missouri X X X
Montana X X X X
Nebraska X X X
Nevada X X X X
New Hampshire X X X
New Jersey X X X X
New Mexico X X** X X
New York X X X X
North Carolina X X X X
North Dakota X X X
Ohio X X X
Oklahoma X X X
Oregon X X X X X
Pennsylvania X X
Rhode Island X X X
South Carolina X X
South Dakota X X X
Tennessee X X X
Texas X X X X X X
Utah X X X
Vermont X X X
Virginia X X
Washington X X X X
West Virginia X X X
Wisconsin X X X X
Wyoming X X
TOTAL: 51 35 8 16 48 11
NOTES: *Includes states with § 1115 waivers without any accompanying § 1915 (c) waivers. **DE, KS, and NM deliver personal care state plan services through their Section 1115 capitated managed care waivers and do not separately report on state plan personal care enrollment, spending, or program policies.
SOURCE:  KFF Medicaid HCBS Program Surveys, FY 2017.
Appendix Table 2:  State Policy Choices for Medicaid Home Health State Plan Benefits, FY 2017
State Optional Therapy Services* Self-Direction Utilization Controls Provider Criminal Background Checks Provider Training Provider Reimbursement Rates
(per visit, unless noted as per hour)
Cost Cap Hour Cap Agency Registered Nurse Home Health Aide
Alabama X X X $27.00/hr
Alaska X $169.36
Arizona X $10.00/hr
Arkansas X $145.02 $66.63
California X X X X X $74.86 $45.75
Colorado X X X $103.63 $36.85/hr
Connecticut X X X X X $95.20/hr $24.64/hr
Delaware X X
DC X X X X $60.00 $90.00 $20.20/hr
Florida X X X X $31.04 $17.46
Georgia X X $61.32 $61.32 $61.32
Hawaii
Idaho X X X $167.96 $58.91
Illinois X X X X $72.00
Indiana X X X $29.62 $42.04/hr $18.31/hr
Iowa X X X $128.50 $117.79 $53.34
Kansas X X X $50.00 $40.50
Kentucky X X X $88.16 $34.13
Louisiana X $42.56
Maine X X X
Maryland X X $97.34 $120.76 $59.99
Massachusetts X X X $89.21 $64.84/hr $24.40/hr
Michigan X X X $80.98 $80.98 $51.72
Minnesota X $57.57
Mississippi X $75.85
Missouri X X X $77.16 $77.16 $77.16
Montana X X $74.31 $74.31 $33.10
Nebraska X X X X $36.57/hr
Nevada X X $64.08/hr
New Hampshire X X $87.36/hr $23.56/hr
New Jersey X X X X $41.83 $49.04 $38.28
New Mexico X X
New York X X
North Carolina X X $109.60 $103.33 $47.28
North Dakota X $120.23 $54.00/hr $120.23
Ohio X X X $47.40/hr $23.57/hr
Oklahoma X $46.07 $63.41 $28.72
Oregon X X X X $193.63 $53.59
Pennsylvania X X X $88.00
Rhode Island X X X $67.18 $67.18 $22.26
South Carolina X X X $99.29
South Dakota X $37.69 $58.72/hr $27.40/hr
Tennessee X X X
Texas X $205.12 $98.92 $148.28/hr
Utah X X $65.03
Vermont X $109.51 $49.44
Virginia X X X $180.02 $73.90
Washington X X $59.99 $63.51 $55.32
West Virginia X X X
Wisconsin X X X $85.54 $32.69/hr $40.31
Wyoming X X $87.75 $130.00 $45.50
TOTAL: 46 5 4 23 36 12 $81.88 average pay rate $86.41 average pay rate $47.28 average pay rate
NOTE: *Optional therapy services include physical, occupational, and/or speech therapy.
SOURCE:  KFF Medicaid State Plan Home Health Program Survey, FY 2017.
Appendix Table 3:  State Policy Choices for Medicaid Personal Care State Plan Benefits, FY 2017
State Service Site, besides beneficiary home Self-Dir. Utilization Controls Provider Type Provider Criminal Background Checks Provider Training Provider Reimbursement Rates (per hour)
Work Other Comm. Setting Cost Cap Hour Cap Agency Indep. Agency Provider
Alaska X X X X $24.40
Arkansas X X NR NR NR NR NR NR
California X X X X X X X $14.00
Colorado X X X X X $19.28
Delaware NR NR NR NR NR NR NR NR NR
DC X X X X X X $20.08
Florida X X X X X $15.00 $15.00
Idaho X X X X X X X $15.76
Kansas NR NR NR NR NR NR NR NR NR
Louisiana X X X X X $11.40
Maine X X X X X X $20.12
Maryland X X X X $16.99
Massachusetts X X X X X X $16.52
Michigan X X X X X $14.25 $9.95
Minnesota X X X X X X X $17.40
Missouri X X X X X $17.22
Montana X X X X X $19.44
Nebraska X X X X $9.78 $9.78
Nevada X X X X X $17.00
New Hampshire X X X X X X
New Jersey X X X X X X X X $41.83 $38.28
New Mexico NR NR NR NR NR NR NR NR NR
New York X X X X X
North Carolina X X X X $15.60
North Dakota X X X X X $37.10 $29.52
Oklahoma X X X X X $15.68
Oregon X X X X X $22.32 $15.00
Rhode Island X X X X
South Dakota X X X X X X $37.38
Texas X X X X X X $13.22 $10.43
Utah X X X NR NR NR NR $19.08 $11.64
Vermont X X X X X X
Washington X X X X X X X $26.32 $13.58
West Virginia X X X X X X $16.00
Wisconsin X X X X $43.02
TOTAL: 23 20 20 1 16 26 13 27 21 $21.03 aver. $16.70 aver.
No Personal Care Program (16 states)
Alabama
Arizona
Connecticut
Georgia
Hawaii
Illinois
Indiana
Iowa
Kentucky
Mississippi
Ohio
Pennsylvania
South Carolina
Tennessee
Virginia
Wyoming
NOTE:  NR = no response.
SOURCE:  KFF Medicaid State Plan Personal Care Program Survey, FY 2017.
Appendix Table 4:  State Section 1915 (c) HCBS Waivers by Target Population, FY 2017 
State Total Number of Waivers Population Served
I/DD Seniors Seniors & Adults with Physical Disabilities Adults with Physical Disabilities Med. Fragile/Tech Dep. Children HIV/AIDS

 

Mental Health TBI/SCI
Alabama 7 X X X X
Alaska 4 X X X
Arkansas 4 X X
California 8 X X X X X X
Colorado 11 X X X X X
Connecticut 10 X X X X X X
Delaware 1 X
DC 2 X X
Florida 7 X X X X X
Georgia 5 X X X X
Hawaii 1 X
Idaho 4 X X
Illinois 9 X X X X X X X
Indiana 4 X X X
Iowa 7 X X X X X X
Kansas 7 X X X X X X
Kentucky 6 X X X X
Louisiana 7 X X X
Maine 5 X X X
Maryland 6 X X X X
Massachusetts 10 X X X X
Michigan 4 X X X
Minnesota 5 X X X X
Mississippi 5 X X X X
Missouri 10 X X X X
Montana 4 X X X
Nebraska 5 X X X
Nevada 3 X X X
New Hampshire 4 X X X
New Jersey 1 X
New Mexico 3 X
New York 10 X X X X X
North Carolina 3 X X X
North Dakota 6 X X X X
Ohio 8 X X X
Oklahoma 6 X X X
Oregon 6 X X X
Pennsylvania 9 X X X X
South Carolina 8 X X X X X X
South Dakota 4 X X X
Tennessee 3 X
Texas 6 X X X
Utah 8 X X X X X X
Virginia 7 X X X
Washington 8 X X
West Virginia 3 X X X
Wisconsin 7 X X X
Wyoming 5 X X X X
TOTAL: 276
waivers
48 states 9 states 37
states
18
states
16
states
7
states
12 states 22 states
No Section 1915 (c) Waivers (3 states)
Arizona
Rhode Island
Vermont
NOTES: I/DD = intellectual and developmental disabilities. TBI = traumatic brain injury. SCI = spinal cord injury. States may offer more than one Section 1915 (c) waiver per target population category. Other states may serve these populations through Section 1115 waivers.
SOURCE: KFF Medicaid HCBS Waiver Survey, FY 2017.
Appendix Table 5:  State Section 1115 HCBS Waivers by Target Population, FY 2017 
State Total Number of Waivers Population Served
I/DD Seniors Adults with Physical Disabilities Med. Fragile/Tech Dep. Children HIV/AIDS Mental Health TBI/SCI
Arizona 1 X X X
California 1 X X
Delaware 1 X X X X X
Hawaii 1 X X X X
New Jersey 1 X X X
New Mexico 1 X X
New York 1 X X X
Rhode Island 1 X X X X X X X
Tennessee 1 X X X
Texas 1 X X
Vermont 1 X X X
TOTAL: 11 5 11 11 2 3 2 3
No Stand-Alone Section 1115 HCBS Waivers (40 states)
Alabama
Alaska
Arkansas
Colorado
Connecticut
DC
Florida
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas**
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
South Carolina
South Dakota
Utah
Virginia
Washington
West Virginia
Wisconsin
Wyoming
NOTES: I/DD = intellectual and developmental disabilities. TBI = traumatic brain injury. SCI = spinal cord injury. Other states serve these populations through Section 1915 (c) waivers. **KS has joint § 1115/1915 (c) waivers.
SOURCE: KFF Medicaid HCBS Waiver Survey, FY 2017.
Appendix Table 6:  State Financial Eligibility Criteria for Medicaid HCBS Waivers by Target Population, FY 2017 
State  I/DD Seniors Seniors & Adults with Physical Disabilities Adults with Physical Disabilities Med. Fragile/Tech Dep. Children HIV/AIDS  Mental Health TBI/SCI
Eligibility Limit as a % of SSI, unless otherwise noted
Alabama 300% 300% 300% 300%
Alaska 300% 300% 300%
Arizona 300% 300%
Arkansas 300% 300%
California 100% FPL 100% FPL 100% FPL 100% FPL 100% FPL 100% FPL
Colorado 300% 300% 300% 300% 300%
Connecticut 300% 300% 300% 300% 300% 300%
Delaware 250% 250% 250% 250% 250% 250% 250%
DC 300% 300%
Florida 300% 300% 300% 300% 300%
Georgia 300% 300% 300% 300%
Hawaii 100% FPL 100% FPL 100% FPL 100% FPL 100% FPL 100% FPL
Idaho 300% 300%
Illinois 100% FPL 100% FPL 100% FPL 100% FPL 100% FPL 100% FPL 100% FPL
Indiana 300% 300% 300%
Iowa 300% 300% 300% 300% 300% 300%
Kansas 300% 300% 300% 300% 300% 300%
Kentucky 300% 300% 300% 300%
Louisiana 300% 300% 300%
Maine 300% 300% 300%
Maryland 300% 300% 300% 300%
Massachusetts 300% 300% 300% 300%
Michigan 100% FPL 300% 300%
Minnesota 95% FPL 300% 95% FPL 95% FPL
Mississippi 300% 300% 300% 300%
Missouri 100% 170% 100% 100%
Montana 100% 100% 100%
Nebraska 100% 100% FPL 100% FPL
Nevada 300% 300% 300%
New Hampshire 300% 300% 300%
New Jersey 300% 300% 300%
New Mexico 300% 300% 300%
New York 100% FPL 84% FPL 100% FPL 100% FPL 100% FPL
North Carolina 100% FPL 100% 100%
North Dakota 100% 100% 100% 100%
Ohio 300% 300% 300%
Oklahoma 300% 300% 300%
Oregon 300% 300% 300%
Pennsylvania 300% 300% 300% 300%
Rhode Island 300% 300% 300% 300% 300% 300% 300% 300%
South Carolina 100% FPL 300% 300% 300% 300% 300%
South Dakota 300% 300% 300%
Tennessee 300% 300% 300% 300%
Texas 300% 300% 300% 300%
Utah 300% 300% 300% 300% 300% 300%
Vermont 300% 300% 300%
Virginia 300% 300% 300%
Washington 300% 300%
West Virginia 300% 300% 300%
Wisconsin 300% 300% 300%
Wyoming 300% 300% 300% 300%
NOTES: I/DD = intellectual and developmental disabilities. TBI = traumatic brain injury. SCI = spinal cord injury. Data include § 1915 (c) and § 1115 waivers. States may offer more than one § 1915 (c) waiver per target population category. Blank cell indicates state does not cover that population.
SOURCE: KFF Medicaid HCBS Program Surveys, FY 2017.
Appendix Table 7:  State HCBS Waiver Self-Direction Policy Choices, FY 2017 
State Self-Direction Allowed Agency-Employed Providers Independent Providers
Select/Dismiss Worker Set Worker Schedule Set Worker Pay Allocate Service Budget Select/Dismiss Worker Set Worker Schedule Set Worker Pay Allocate Service Budget
Alabama X X X X X X X X
Alaska
Arizona X X X X X
Arkansas
California X* X X X X
Colorado X* X X X X X X
Connecticut X* X X X X X X X X
Delaware X* Agency providers not covered X X
DC X X X X X Independent providers not covered
Florida X* X X X X X X
Georgia X Agency providers not covered X X X X
Hawaii X* Agency providers not covered X X X
Idaho X X X X X X X
Illinois X* X X X X X
Indiana X Agency providers not covered X X
Iowa X* Agency providers not covered X X X X
Kansas X X X X X
Kentucky X* X X X X X
Louisiana X* Agency providers not covered X X X X
Maine X X X X X X X
Maryland X* X X X X Independent providers not covered
Massachusetts X* X X X X X X X X
Michigan X X X X X X X X X
Minnesota X* X X X X X X X X
Mississippi** X* Agency providers not covered X X
Missouri X X X X X X X
Montana X* X X X X X X X
Nebraska X* X X X X X X
Nevada
New Hampshire X* X X X X X X X X
New Jersey X* X X X X X X X X
New Mexico X* X X X X X X X X
New York X X X X X X X
North Carolina X* X X X X X
North Dakota X* X X X X X X X
Ohio X* X X X X X X X X
Oklahoma X* Agency providers not covered X X X X
Oregon X Agency providers not covered X X X
Pennsylvania X* X X X X X X X
Rhode Island X Agency providers not covered X X X X
South Carolina X* X X X X
South Dakota X* X X X X Independent providers not covered
Tennessee X* Agency providers not covered X X X X
Texas X* X X X X X X
Utah X* Agency providers not covered X X X
Vermont X* Agency providers not covered X X X X
Virginia X* Agency providers not covered X X
Washington X* X X X X X X
West Virginia X* X X X X Independent providers not covered
Wisconsin X* X X X X X X X X
Wyoming X* Agency providers not covered X X X X
TOTAL: 48 30 32 16 20 44 44 31 32
NOTES: HCBS waivers include § 1915 (c) and § 1115. *Denotes family members can be paid as independent providers. **Self-direction not available statewide in MS.
SOURCE:  KFF Medicaid HCBS Program Survey, FY 2017.
Appendix Table 8:  State HCBS Waiver Utilization Control, Quality Measure and Ombuds Policy Choices, FY 2017 
State Utilization Controls Quality Measures Ombuds Programs
Cost Cap Hour Cap Geo. Limit Quality of Life Community Integration LTSS Rebalancing Within State Government Outside State Government
Alabama X X X X
Alaska X X X X
Arizona X X X
Arkansas X X
California X X X X X X
Colorado X X X X X
Connecticut X X X X
Delaware X X X X X
DC X X X
Florida X X X X X
Georgia X X X
Hawaii X X X X
Idaho X X X X X
Illinois X X X X
Indiana X X X
Iowa X X X X X X
Kansas X X X X X
Kentucky X X X X X
Louisiana X X X X X X
Maine X X X X NR
Maryland X X X X NR
Massachusetts X X X X X X
Michigan X X X X
Minnesota X X X X X X
Mississippi X X X X
Missouri X X NR
Montana X X X X
Nebraska X X X X
Nevada X X X
New Hampshire X X X X
New Jersey X X X X NR
New Mexico X X X X X
New York X X X X X
North Carolina X X X X NR
North Dakota X X X X
Ohio X X X X
Oklahoma X X X X X
Oregon X X X
Pennsylvania X X X
Rhode Island X X X X X
South Carolina X X X X
South Dakota X X X X X
Tennessee X X X X X
Texas X X X X X
Utah X
Vermont X X X X
Virginia X X NR
Washington X X X X X
West Virginia X X X X X
Wisconsin X X X X X
Wyoming X X X X X X X
TOTAL: 37 20 4 48 42 17 37 12
NOTE: HCBS waivers include § 1915 (c) and § 1115. NR indicates state did not respond to question.
SOURCE:  KFF Medicaid HCBS Program Survey, FY 2017.
Appendix Table 9:  State MLTSS Policy Choices, FY 2017
State LTSS Provider Network Adequacy Standards Independent Enrollment Options Counseling Disenrollment if LTSS Provider Leaves Plan Network Stakeholder Advisory Committee
State-Level Health Plan Level
Arizona X X X X
California X X X X
Delaware X X X X X
Florida X X X X X
Hawaii X X X
Idaho X X
Illinois X X X X
Iowa X X X X X
Kansas X X X X X
Massachusetts
Michigan X X X X
Minnesota X X X
New Jersey X X X X
New Mexico X X X X
New York X X X
North Carolina X
Ohio X X X X X
Rhode Island X X X X
South Carolina
Tennessee X X X X X
Texas X X X X X
Vermont X X
Virginia X
Wisconsin X X X X X
TOTAL: 14 17 14 20 18
No MLTSS Program in 2017 (26 states):
Alabama
Alaska
Arkansas*
Colorado
Connecticut
DC
Georgia
Indiana
Kentucky
Louisiana
Maine
Maryland
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
North Dakota
Oklahoma
Oregon
Pennsylvania*
South Dakota
Utah
Washington
West Virginia
Wyoming
NOTES: *PA’s § 1915 (b)/(c) waiver was approved in Feb. 2018. AR’s § 1915 (b)/(c) waiver was approved in Jan. 2019.
SOURCE:  KFF Medicaid HCBS Program Survey, FY 2017.
Appendix Table 10:  State Policy Choices About HCBS Settings Rule, FY 2017
State State Rule/Policy Change Needed Settings Must Be Modified Settings Cannot Be Modified Plan To Submit Information to Overcome Institutional Presumption Settings Presumed Institutional Because Effectively Isolate Beneficiaries
Alabama X X (3) X (1) X (2)
Alaska X
Arizona X X (7) X (5)
Arkansas X (TBD) X (17) X (TBD)
California X X X
Colorado X X (3) X X
Connecticut X X (50) X (4)
Delaware X X (460) X (1) X (1)
DC X X
Florida X (TBD) X (TBD) X (TBD) X (TBD)
Georgia X
Hawaii X X (1,368) X (1) X (1)
Idaho X X (97) X X (121)
Illinois X X (5) X
Indiana X X (TBD) X X (TBD)
Iowa X X (1) X (5) X (3)
Kansas NR
Kentucky X X X X
Louisiana X X (4) X (1)
Maine NR
Maryland X X (TBD) X (5)
Massachusetts NR
Michigan X X (900) X (35) X (TBD)
Minnesota X X (135)
Mississippi X X
Missouri X X (35) X (21)
Montana X X (294) X (16)
Nebraska X X (TBD) X (1) X (60) X (TBD)
Nevada X X (TBD) X (1)
New Hampshire X X X (5) X (66)
New Jersey X X
New Mexico X
New York X X (522) X (189) X (215)
North Carolina X X X (20)
North Dakota X
Ohio X X (342) X (TBD) X (70) X
Oklahoma X X X (2)
Oregon X X (946) X X (5) X (5)
Pennsylvania X
Rhode Island X X (TBD) X (2) X (12) X (3)
South Carolina X X (1,122) X X (TBD)
South Dakota X X (25) X (43) X (10)
Tennessee X X (189) X (23) X (TBD) X (TBD)
Texas X X (TBD)
Utah X
Vermont X
Virginia X X (TBD) X X (TBD)
Washington X X (8)
West Virginia X (1)
Wisconsin X X (TBD) X (TBD) X, TBD
Wyoming X X (2)
TOTAL: 45 36 11 32 23
NOTES:  NR indicates state did not respond to question. Numbers in parentheses indicate number of settings. TBD indicates number of settings to be determined.
SOURCE:  KFF Medicaid HCBS Program Survey, FY 2017.
Appendix Table 11:  State Policy Choices About Direct Care Worker Minimum Wage and Overtime, 2015-2017
State Plan To Restrict Worker Hours or Make Other Policy Change Limit Worker Hours to 40 hours/week Budget State Funds for Worker Overtime Pay Budget State Funds for Worker Travel Time Pay
2015 2016 2017 2015 2016 2017 2015 2016 2017 2015 2016 2017
Alabama X X X X
Alaska
Arizona
Arkansas
California X X X X X X X X X
Colorado
Connecticut X X X X
Delaware X
DC
Florida
Georgia X
Hawaii X
Idaho
Illinois X X X X
Indiana
Iowa X X X X
Kansas X X
Kentucky X X X X X X
Louisiana
Maine X X X X
Maryland X
Massachusetts X X X X
Michigan
Minnesota
Mississippi X X
Missouri
Montana
Nebraska X X X X
Nevada
New Hampshire X X
New Jersey
New Mexico X X X X X X
New York
North Carolina
North Dakota X
Ohio X
Oklahoma X X X X
Oregon X X X X* X* X X X X
Pennsylvania X X X
Rhode Island
South Carolina X X X X X X
South Dakota
Tennessee X
Texas
Utah
Vermont
Virginia X
Washington X X X X* X* X X X X X X
West Virginia
Wisconsin X X X X X X
Wyoming X X X X
TOTAL: 7 15 15 4 7 6 7 10 13 5 7 10
NOTES: *50 hour limit in Oregon for some providers; independent respite care providers are limited to 65 hours in Washington.
SOURCE:  KFF Medicaid HCBS Program Surveys, FY 2015-2017.

 

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