Section 71121 of the Working Families Tax Cut legislation established a new 1915(c)(11) Home and Community-Based Services (HCBS) waiver authority to support access to HCBS before individuals meet an institutional level of care. The legislation appropriated $100 million for state planning and implementation support and directed the Centers for Medicare and Medicaid Services (CMS) to begin approving these waivers by July 2028. On July 22, 2026, CMS hosted a webinar outlining conditions for approval, ongoing requirements, and implementation timelines. While written guidance is still forthcoming, CMS clarified enough for states to begin readiness assessment and waiver design now.

CMS clarified that states seeking a 1915(c)(11) must:

• Establish functional, needs-based eligibility criteria that are less stringent than institutional level-of-care criteria — as a floor for eligibility, not a ceiling. Some individuals who could meet institutional LOC may still qualify, depending on waiver design. Age and diagnoses can be additionally applied to create target groups.
• Comply with all existing 1915(c) requirements, including person-centered planning, cost neutrality, and quality reporting.
• Show the waiver won’t cause a “material increase” in wait times for individuals at an institutional level of care. States with existing 1915(c) waitlists may still operate a 1915(c)(11), provided that the wait doesn’t increase.  CMS stated further policy clarification is forthcoming.
• Keep per capita spending below institutional care spending and report annually on cost, service duration, and enrollment.

CMS also provided additional details in response to participant questions about the timeline between now and July 2028 waiver approvals. Specifically, CMS intends to soon send states an award letter stating their share of the $100 million (which will be 100% federal funds, with no state match requirement); issue a waiver application and updated Technical Guide by the end of calendar year 2027, giving states three months to apply and CMS three months to review ahead of July 2028 approvals; and apply the same FMAP as other waiver programs once waivers are approved.

Why This Matters for States

Based on CMS’s July 2026 webinar, states appear positioned to use their share of the $100 million in federal funding to evaluate whether a 1915(c)(11) waiver is a viable strategy for expanding earlier access to HCBS before applications are due. The authority may be especially useful for states looking to reach people on existing waiting lists, individuals with behavioral health needs, chronic conditions, or who need early intervention support, or geographically targeted populations where community-based service gaps are most acute.

Because eligibility is a floor rather than a ceiling, some higher-need individuals could qualify for multiple waivers or waitlists, so states will need clear policies to route people to the right pathway. Provider capacity is just as critical: even before CMS defines “material increase,” states should gauge whether provider networks, rates, and workforce can absorb a new waiver population without eroding access for people already served.

Start Cross-Agency Exploration of 1915(c)(11) Waiver Options Now

A deliberate, cross-agency planning process — spanning Medicaid, operating agencies, your state budget office, providers, advocates, and people with lived experience across aging, I/DD, physical disability, and behavioral health populations — will help states judge whether a 1915(c)(11) waiver is feasible, sustainable, and aligned with broader LTSS goals.

Without it, states risk creating eligibility criteria that overlap with existing waivers instead of clearly distinguishing pre-institutional need, causing wait times to increase for individuals with institutional level of care, and creating fiscal or reporting gaps from insufficient modeling. Early coordination protects existing waiver capacity and builds a stronger case for CMS approval.

Next Steps You Can Take Today

1. Convene a cross-agency planning group to align Medicaid, operating agencies, finance, quality, and program leadership.
2. Identify potential target populations using available claims, assessment, waitlist, utilization, and stakeholder data.
3. Assess service need using claims, wait times, and stakeholder data.
4. Begin fiscal and operational modeling to understand financial feasibility and to prepare for future CMS application and reporting requirements.
5. Analyze provider capacity to understand whether proposed services can be delivered without affecting existing waiver access.

Connect with us to evaluate whether and how a 1915(c)(11) waiver can benefit your state.

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

About the Author

Katie Alijewicz is a Senior Consultant with Public Consulting Group and a Project Management Professional (PMP) with more than a decade of experience in Medicaid, long-term services and supports, budgeting, rate setting, and grant management. She has led complex health and human services initiatives for PCG, including the development of the new Community Support Waiver (CSW) for the Kansas Department for Aging and Disability Services (KDADS). She previously served as Deputy Director/CFO of the Rhode Island Medicaid Program and Assistant Budget Director for the Massachusetts Executive Office for Administration and Finance. Katie has managed state budget development, cross-agency LTSS initiatives, acuity-based rate projects, Medicaid fee-for-service and managed care financial models, and the development and implementation of Rhode Island’s ARPA HCBS Spending Plan. She helps public agencies design and implement programs that are financially sound, operationally practical, and responsive to the needs of the people they serve.