From August 23 – 27, 2026, the HCBS Conference in Baltimore, MD turned its attention to the new 1915(c)(11) waiver, with the Centers for Medicare and Medicaid Services (CMS), Administration for Community Living (ACL), National Association of State Directors of Developmental Disabilities Services (NASDDDS) and ADvancing States all weighing in on how states can put this new authority to work. A panel of state intellectual/developmental disability (I/DD) leadership from Massachusetts, Missouri, and Kentucky also shared early thinking on how the waiver could support people in their states, giving other states a first look at what design choices might look like in practice.

States considering a 1915(c)(11) waiver should know:

• Eligibility must be needs-based, built around limitations in activities of daily living (ADLs) or instrumental activities of daily living (IADLs), rather than tied to a specific age or diagnosis. States that want to reach a narrower group, such as children with complex and varied support needs, can layer age or diagnostic criteria on top of that needs-based foundation.
• A single 1915(c)(11) can serve multiple target populations, as long as administration and service offerings are consistent across all of them.
• The waiver is available to states operating managed care systems, not just fee-for-service states.
• All existing 1915(c) requirements still apply, plus some additional ones, such as the requirement that states must show the waiver won’t create a material increase in average wait times for individuals who meet an institutional level of care.
• $100 million in funding will be distributed to states, with State Medicaid Directors expected to receive award letters in October 2026 and funds available by the end of the calendar year.

What States Are Exploring

The state panel offered a glimpse of the range of populations and goals this waiver could serve. Massachusetts is exploring how the waiver could support adults with autism. Missouri is looking at extending coverage to individuals with I/DD who are at risk of incarceration or involvement in the justice system. Kentucky is eyeing its state-funded Home Care program, seeing the waiver as a potential source of federal revenue for a program that currently runs entirely on state dollars. ACL also pointed to employment supports as another area states could target, and CMS noted other possible populations, including children in foster care, individuals with behavioral health needs, and older adults with more modest support needs.

Why This Matters Now

Even though CMS won’t begin approving waivers until July 1, 2028, the runway between now and then is shorter than it looks once planning, guidance, and review timelines are laid out. CMS expects to release a fully updated Technical Guide covering the 1915(c)(11) waiver by January 1, 2028, leaving states time to review and meet CMS’s requirement for a 90-day review window ahead of the July 2028 start date.

CMS was clear that state input can still shape the guidance that’s coming. Questions and feedback can be sent to [email protected], giving states a direct channel to influence how the requirements are ultimately written.

Next Steps You Can Take Today

1. Begin stakeholder engagement now, using existing 1915(c) requirements and current knowledge of the 1915(c)(11) framework as a starting point.
2. Submit questions or input to CMS at [email protected] to help shape forthcoming guidance.
3. Review your state’s current functional criteria for institutional level of care to understand where a below-institutional threshold could be set.
4. Assess existing 1915(c) systems and processes to identify opportunities for quality improvement ahead of a new waiver launch.
5. Identify which populations and program goals, such as those raised by Massachusetts, Missouri, and Kentucky, align best with your state’s needs and existing infrastructure.

Ready to Explore the 1915(c)(11) Waiver for Your State?

States that start early – engaging stakeholders, reviewing functional criteria, identifying target populations, and weighing in with CMS – will be best positioned when applications open. Our team can help you assess readiness, model program design options, and incorporate CMS guidance as it’s released.

Contact our HCBS experts today to start planning your state’s approach.

(800) 210-6113 | [email protected] | 1915(c)(11) Waiver Solutions

Explore Our Past Insights on This Topic

This isn’t the first time our team has covered the 1915(c)(11) waiver. For a deeper look at how the authority works and what states should know as they begin planning, revisit our earlier coverage:

• Fundamentals of the 1915(c)(11) Waiver Authority — a breakdown of the waiver’s core structure, eligibility framework, and how it fits alongside existing 1915(c) programs.
• Unlock New Federal Supports for Aging Programs— a look at how states can apply this waiver to reach older adults earlier and support aging services with new federal dollars.
• PCG’s Role in Kansas’ Rapid 1915(c) Waiver Approval — see how PCG supported Kansas in launching a groundbreaking waiver program that expands choice, independence, and access to services for individuals with I/DD.

Together with the updates from the 2026 HCBS Conference, these pieces can help your team build a fuller picture of the waiver’s requirements, funding, and potential applications as CMS guidance continues to take shape.