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Assurance 1 - Level of Care

Participants enrolled in the HCBS waiver meet the level of care criteria consistent with those residing in institutions.

What are the requirements of this HCBS waiver assurance?

Your state must assure that people getting services under the HCBS waiver would otherwise qualify for Medicaid-reimbursed institutional care. Before CMS approves an HCBS waiver, a state must provide detailed descriptions of how level of care determinations will be made.

The state must show that it has:

  • Criteria and methods for determining qualifications for institutional level of care. (click here for more information on institutional level of care)
  • Qualified agencies to conduct the level of care evaluations. (click here for more information on level of care evaluations)
  • A schedule for evaluating, at least annually, that a person continues to meet institutional level of care. (click here for more information about schedule for evaluating level of care)

Medicaid participants who meet an institutional level of care may receive HCBS waiver services, provided there is a funded opening. If there is no opening, the person may be put on a state’s waiting list, even though they are eligible for services now. If a person is found not to be eligible, he/she can appeal the decision to the state.

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