Federal officials are delaying enforcement of a new mandate aimed at helping people with disabilities experiencing issues accessing Medicaid home and community-based services.
The Centers for Medicare and Medicaid Services said recently that it will hold off on a requirement that states establish a grievance system.
Under a 2024 regulation known as “Ensuring Access to Medicaid Services,” or the Access Rule, states must create a grievance process so that beneficiaries in traditional Medicaid plans can file complaints against a provider or state if they have trouble receiving the home and community-based services called for in their service plan. A similar process already exists for those receiving services through managed care plans.
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The new option was supposed to be in place by July 9, but now CMS says it will not take any enforcement action until Dec. 31, 2027.
“Some states have indicated that they will be unable to meet the July 9, 2026 applicability date that we finalized for the grievance system requirements, at least in part because of the time required to implement changes to existing electronic systems or to implement new electronic systems,” said Dan Brillman, deputy administrator at CMS and director of the Center for Medicaid and CHIP Services, in a bulletin. “While states are not required to have electronic systems to meet the (fee-for-service) grievance system requirements, the exercise of enforcement discretion will support states by allowing additional time, at a state’s option, to implement electronic, integrated grievance and incident management systems and to meet the reporting requirements.”
In addition to the grievance system, the Access Rule stipulates that those receiving home and community-based services have service plans that are reassessed annually. It mandates that states maintain an electronic incident management system and details how quickly they must respond to incidents. The rule also sets minimum payment thresholds for direct care providers.
The grievance system could apply if an individual is living in a home where a provider is restricting visitor access or preventing residents with disabilities from going out into the community, among other circumstances, said Alison Barkoff, a health law and policy professor at George Washington University who led the U.S. Department of Health and Human Services’ Administration on Community Living under the Biden administration.
“While it is disappointing that people receiving HCBS will continue to have to wait for this important process, I hope that states will use the extra time to develop a best practice grievance system — an electronic system that will integrate with their incident management system (focused on health and safety) that is also required under the rule,” Barkoff said. “Disability advocates encourage states to move as quickly as possible in getting these systems in place, even absent enforcement by CMS.”
