In addition to the Medicaid state plan benefits, in 1981, Congress authorized HCBS waivers under Section 1915(c) of the Social Security Act (SSA). Home and Community-Based Services State Plan Option: Section 6086 of the Deficit Reduction Act

Section 6086 of the Deficit Reduction Act of 2005 (DRA, P.L. 109-171 ) authorized a new optional benefit that allows states to cover limited HCBS without waivers. The requirements of this new optional benefit, Section 1915(i) of SSA, differ from other Medicaid state plan benefits (e.g., home health and personal care) and the Section 1915(c) HCBS-waivers. Table 2 compares key features of the new HCBS benefit with existing Medicaid program authorities. Section 1915(i) authorizes states to offer HCBS without a waiver beginning in January 2007.
Section 6086 of the Deficit Reduction Act of 2005, (DRA, P.L. 109-171), established a optional Medicaid benefit giving states a new method with which to cover home- and community-based (HCBS) services for Medicaid beneficiaries, starting in January 2007. Prior to DRA's enactment, states needed HCBS waivers authorized in Section 1915(c) of the Social Security Act (SSA) to cover these services. The HCBS-state plan optional benefit, Section 1915(i), differs from both existing Medicaid state plan benefits and Section 1915(c) waivers. This report outlines requirements of the new 1915(i) benefit and compares key features of this benefit with other Medicaid state plan benefits and 1915(c) waivers. It will be updated periodically.