Understanding the HCBS Settings Rule

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What is the HCBS Settings Rule?

The HCBS Settings Rule is a policy that that protects individuals who receive Home and Community Based Services (HCBS) through a Medicaid waiver. The rules makes sure people have full access to the benefits of community living and are able to receive services in the most integrated setting.




Published 5/08/2023

DOI: Forthcoming
Settings Rule (1)

How does the HCBS Settings Rule protect people with disabilities?

The HCBS Settings Rule protects the rights of people with disabilities to live and receive services in their communities. These rights include:

  • Right to live in your community*
  • Right to choose where you live
  • Right to choose where you receive services
  • Right to choose what services you get
  • Right to privacy and respect
  • Right to be free from restraint and seclusion
*This means that people who get HCBS cannot be forced to live in an institution.

The HCBS Settings Rule also tells HCBS providers what rules they must follow.

The provider is like a landlord, and individuals receiving HCBS are like tenants.

Tenants you have the following rights:

  • You can lock the door to your room (if you choose)
  • You can decorate your living space as you want
  • Your housing must be wheelchair accessible
  • You can access food any time (food is not withheld)
  • You can have visitors at any time


What is the result of the HCBS Settings Rule?

  • This policy requires more integration of people with disabilities in their communities and supports to access the community.
  • Providers will have to rethink their program design if individuals with disabilities are not integrated with people who are not receiving HCBS. Services also cannot be provided in disability-specific settings. This means that providers may not be able to bill Medicaid for services that are delivered in a setting with only autistic people.

Important next steps:

  • It will be critical to monitor how states implement the HCBS Settings Rule to make sure people’s rights are being honored.
  • Autistic individuals (and/or their family members) must be aware of their rights in HCBS Settings in order to advocate well. This means that information must be provided in plain language versions.
  • Providers also need training to make sure they understand the new expectations for people’s rights in HCBS settings.