Friday, November 21, 2014

Michigan: Links and information on HCBS transition plans

New federal rule for HCBS settings: integration or limited choice?

In January 2014, the federal Centers for Medicare and Medicaid Services (CMS) issued a new rule for Home and Community Based Service (HCBS) settings that restricts the use of Medicaid funds to settings that are deemed to be integrated into the community as determined by CMS and in CMS approved state plans for implementation of the new rule. The new rule applies to all Medicaid waivers and the overall State Plan that lays out how the state intends to provide services and residential supports to people with developmental (and other) disabilities.

States have a maximum of 5 years to comply with the new rule and there should be numerous opportunities for public comment on the transition plans for implementation. The transition plan for a modified Habilitation Supports Waiver (HSW) for people with developmental disabilities has been proposed and public comments to the Michigan Department of Community Health were due on September 26, 2014.(Don't let due dates bother you too much; you can always comment to state and federal officials on public policy any time you feel moved to do so, but adhering to deadlines doesn't hurt.)

Another transition plan for the state will be available for public comment soon. You can keep updated on transition plans, modifications to waivers and state plans, and dates for public comment at this Website, HCBS Advocacy, and here, at the Website page specifically for Michigan. Other background information is also available.

Reading some of the materials may make you feel like you have entered Alice's Adventures in Wonderland, and you have my sympathy. The main things to keep in mind are:

  • Are the plans and proposals you are being asked to comment on clear and understandable to you so that you know exactly what the state has in mind? If not, that may be your first comment.
  • How will the plan or proposal affect your disabled family member (or friend)? 
  • What if things change in the future for your family member? Will the proposal or plan allow enough flexibility to anticipate future events or changes in need that may affect services and living arrangements for your family member.
In other words, you shouldn't have to be a policy expert to read and interpret changes that could have a significant effect, good or bad, on the person with a disability and your family. Start with what you know and do the best you can. Ask a lot of questions where the policy is unclear or you think the state (or the CMS) has not thought through the long-term consequences of their proposals.

Links to the Final Regulation from CMS on the HCBS settings rule.
Webinar from the Michigan Department of Community Health on the MI Transition plan.
Frequently Asked Questions from ACCSES, a national providers organization.
Coalition for Community Choice ; The contact for CCC is Desiree Kameka at

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