Advocates seek CMS direction on HCBS

Disability advocacy organizations are asking CMS for clarification on new HCBS expansion authority created under the Reconciliation Act (HR 1), citing the need for clear technical guidance before states move forward with waiver changes.

What advocates are requesting from CMS 

Leading disability advocacy organizations, including AAHD, Lakeshore Foundation, and the CCD Task Force, formally requested CMS clarification on the expanded HCBS waiver authority established under HR 1.

In their letter, advocates asked for technical guidance on how states may operationalize this expanded authority. The stated goals include increasing HCBS capacity, reducing institutional bias, and expanding access to community-based service options.

Advocates also requested clearly defined implementation parameters. They framed this as necessary for states to develop compliant waiver proposals under the new authority.

Why the request matters now 

The request points to uncertainty among states about how broadly the expanded authority can be applied. Without CMS interpretation, states may be less likely to pursue waiver expansion because of compliance risk.

The letter signals that states may be waiting for clearer direction on what is permissible and how CMS expects expanded authority to be used in practice.

If CMS issues formal guidance, advocates suggest it could open new waiver design pathways. The areas referenced include expanded populations, innovative service models, and strengthened community-based supports.

What this could mean for provider strategy 

For agency leadership, expanded waiver authority could create long-term growth opportunities for providers, but the impact depends on whether CMS guidance clarifies permissible uses and safeguards.

Leaders are advised to monitor forthcoming CMS communications and remain flexible in strategic planning, given that federal clarification may shape future waiver expansion opportunities at the state level.

The update also notes that engaging with state Medicaid agencies and advocacy partners now may position providers to participate in future waiver development efforts.