Many individuals with disabilities want housing that offers them more integration in the community and a greater sense of independence than institutional settings. Yet they have been waiting since 2014 for federal officials to enforce the rules that such community-based housing services are supposed to meet. Early next year, the federal standards defining what qualifies as community housing will finally be imposed on states.

The rules, designed to help protect the independence, dignity, and integration of people with disabilities who are beneficiaries of the Medicaid-funded Home and Community-Based Services (HCBS) program, will come into force in March 2023.

The Centers for Medicare and Medicaid Services (CMS) issued the standards to ensure that the program's million-plus beneficiaries face none of the restrictions associated with residential health care institutions. For housing to qualify under the program, residents must be allowed to come and go as they like, receive visitors whenever they wish, lock their doors, receive food deliveries, and decorate their living spaces as they see fit, among other liberties taken for granted by tenants and homeowners elsewhere.

The federally and state-funded HCBS program is intended to give people with disabilities living independently the Medicaid insurance coverage that has long been available to those residing in hospitals and other health care institutions. Such services include health care aide assistance, medical equipment, transportation, and treatment.

CMS originally gave states until 2019 to comply with the standards, but the deadline has been extended more than once, most recently due to the COVID-19 pandemic.

“We're glad to see CMS is holding firm to the 2023 deadline,” said Julia Bascom, executive director of the Autistic Self Advocacy Network. “People with disabilities will have been waiting nine years for the basic rights guaranteed by the rule, like the right to lock our doors, decorate our rooms, and eat when we're hungry.”

The HCBS program was introduced in 1981 under the Reagan administration, which found that people with disabilities could live independently at a sixth of the cost of residing in an institutional setting. Under the program, the federal government granted “waivers” to states, allowing them to offer Medicaid coverage to those living in their own homes.