National Organizations Release Toolkit to Help Stakeholders Advocate for Strong Implementation of HCBS Settings Rule

a toolkit graphicThe Bazelon Center for Mental Health Law in Washington, D.C., along with other disability and aging advocacy groups, has issued a Toolkit to help advocates push for strong implementation of the new Home and Community Based Services (HCBS) Settings Rules in their states.

The new HCBS Settings Rules require all settings funded by Medicaid HCBS programs to:

  • provide opportunities for participants to be integrated in and engage in community life,
  • have access to the community,
  • control their personal resources,
  • provide opportunities for people to seek employment and work in competitive integrated settings, and
  • ensure the person receives services in the community to the same degree of access as individuals not receiving Medicaid home and community-based services..

For these new rules to have “a real impact and move states towards more integrated and individualized services, advocates must get engaged now and push for a strong transition plan,” said Alison Barkoff, Bazelon’s Director of Advocacy. All states have already submitted to CMS their initial transition plans, and CMS has provided feedback to states about needed improvements and next steps for amending and implementing their plans. “The next several months are a critical time for advocacy because that is when states will be making important decisions about their transition plans,” she said.

a graphic of  the letter 'i' for informationThis new toolkit provides advocates with detailed information about the HCBS Settings Rule and provides action steps for advocates to impact implementation of the new rules in their states. The toolkit contains three documents:

  1. The Medicaid Home and Community-Based Services Settings Rules: What You Should Know;
  2. Home and Community-Based Services Regulations Q&A: Settings Presumed to be Institutional & the Heightened Scrutiny Process, and
  3. The Home and Community-Based Settings Rules: How to Advocate for Truly Integrated Community Settings (unabridged and abridged).

States have until March 2019 to transition their HCBS programs into full compliance with the new settings requirements. The Bazelon Center developed this toolkit with a coalition of other disability and aging advocates working together for strong implementation of the HCBS Settings Rule.

Which Types of Settings are Affected?

Type of Setting

Provider-Owned or Controlled

Residential Providers*
  • Group Homes
  • Family Centered Support Homes
  • Shared Living
  • Certain PNMIs
Non-Residential Providers
  • Adult day health centers
  • Center-based community support
  • Enclaves and sheltered work shops

*Rules apply to the setting in which a member receiving HCBS is living, whether or not the member receives HCBS in that setting.

The Bazelon Center’s advocacy around the HCBS Settings Rule is funded in part by the Ruderman Family Foundation.


Want more information?

To learn more, see and, a website with up-to-date information about the rules and states’ implementation maintained by several member organizations in the coalition.

To see a copy of the Statewide Transition Plan (STP) that was submitted by Rhode Island or any other State, click here.

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