Medicaid section 1915(c) home and community-based services waiver policy flexibilities during the COVID-19 public health emergency: state agency, provider, and consumer experiences

States may use Appendix K to modify their existing Medicaid home and community-based services (HCBS) 1915(c) waiver programs during emergency situations. During the COVID-19 public health emergency, states used Appendix K to make temporary changes to access and eligibility, payment, services, and other aspects of their waiver programs. For example, Wyoming allowed Medicaid enrollees in their Community Choices Waiver who participate in self-direction to hire and pay spouses to provide personal support services. Maine rapidly scaled up infrastructure to expand self-direction. Maine was the only state in our sample that implemented an Appendix K flexibility expanding self-direction, others cited existing self-direction programs, lack of infrastructure, and lack of staff or administrative capacity, rather than a lack of interest, as reasons for not expanding self-direction.News body content