HCBS Definition Project

What is the HCBS Definition Project?

With funding from The SCAN Foundation, HSRI worked with a range of expert partners to describe the essential elements of “home and community-based services,” or HCBS, and to propose a consensus definition of HCBS.

Project Vision

Home and community-based services and supports enable people with disabilities and older adults to live with dignity and independence in their homes and local communities. However, the term “HCBS” is used inconsistently across programs, populations, and systems. Without a shared definition, policymakers, advocates, providers, and people who use services face barriers to service alignment, cross-agency planning, advocacy, and policy coherence. This project developed a payer-neutral consensus definition of HCBS that is relevant across populations and practical for policy use.

WHY: What is HCBS meant to do?
WHO: Who is this about?
WHAT: What counts as HCBS?
WHERE: What does “home and community” mean?
BY WHOM: Who provides HCBS?
DURATION: Is HCBS ongoing?

Purpose of this Definition of HCBS (preamble)

The goal of this project is to create a definition of HCBS that can support:

Policy development

Legislative drafting

Advocacy efforts

This definition should be:

Payer-neutral (not tied to Medicaid or any one program)

Relevant across populations who have needs for functional supports – this includes all ages and disability groups

Practical and usable in real policy settings

The definition is intentionally grounded in the values of choice, autonomy, and self-direction, recognizing that while people experience ‘home’ in many ways, policy must clearly distinguish community-based supports from models that replicate institutional control.

Final Definition of HCBS V5 (via May 2026 Consensus Panel Meeting)

Home and community-based services (HCBS) are a range of supports provided to people in their home and local communities.

HCBS assist people of all ages who need help to live or remain at home and engage in community life. HCBS may be short-term, long-term, or intermittent. They help people to exercise their right to have choice and control over their lives, including where and with whom they live, and their day-to-day activities, including work, school, or other meaningful ways they engage in their community.

HCBS may include supports such as:

help with everyday activities, including personal care and other services in people’s homes;

health-related and behavioral health supports;

assistance to do things outside their home, including transportation;

employment and other chosen day activities;

supports for family and unpaid caregivers;

home modifications and enabling technologies; and service coordination and navigation across systems, among others.

HCBS can be provided in places such as a person’s home, workplace, school, and other community locations. HCBS help people to live, work, and spend time in places they choose that are part of the broader community.

History

In 2025, The SCAN Foundation contracted with Human Services Research Institute (HSRI) to develop a consensus definition of HCBS that can support policy development, legislative drafting, and advocacy. The concept of HCBS dates to the 1960s and centers on providing services and support in homes and communities rather than institutions. This vision has been advanced through federal regulations, policies, and programs.

Strategic Aims

As part of the HCBS Definition Project, HSRI:

Conducted an environmental scan of how HCBS is defined across federal and state agencies, research literature, advocacy organizations, and provider groups.
Convened a national Advisory Group of individuals with deep experience in policy, research, and service delivery across systems to guide the project.
Gathered insights from multiple perspectives by:
- Conducting a targeted survey of professionals and others with experience in planning for, accessing, and providing HCBS.
- Conducting in-depth key informant interviews with people who receive, provide, study, or advocate for HCBS.
Synthesized findings on how HCBS is defined, feedback on what a consensus definition should include and how it could be used, and key considerations for the Consensus Panel.
Convened a Consensus Panel of experts to develop the consensus definition.
Disseminated results broadly to support uptake and impact.

Impact

A consensus definition of HCBS can support policymaking, legislative drafting, quality measurement, and advocacy by giving stakeholders shared language to describe services, align priorities, and expand access.

Supplemental Materials

HSRI developed supplemental materials to provide context for the definition and support its use.

Health Affairs Forefront Article: Presents the consensus definition and summarizes the evolution of HCBS, recent federal initiatives, and major project components.
What We’ve Learned: Foundational Research: Summarizes findings from the project’s foundational research, including key takeaways and focus areas for the Consensus Panel.
1. Environmental Scan Brief Report: Provides information for the project’s environmental scan and the implications for the consensus definition.
2. Key Informant Report: Provides information for the project’s key informant interviews and the implications for the consensus definition.
Consensus Definition: Presents a preamble and the consensus definition.
Service & Support Categories: Provides examples of HCBS service and support categories; the list is illustrative rather than exhaustive.
Personas: Uses examples or personas to test the definition’s applicability and illustrate the range of people, settings, services, and supports included in HCBS.
HCBS Terms: Defines common terms associated with HCBS across Medicaid and other service systems.