Healthcare / HHS / CMS
Medicaid Home & Community-Based Services
Money reaches recipients indirectly: the federal government pays each state its Federal Medical Assistance Percentage (FMAP) share (roughly 50 to 84 percent) of the cost of HCBS the state covers under a CMS-approved 1915(c) waiver, 1915(i)/(j)/(k) state plan option, or 1115 demonstration. There is no per-state allocation table and no NOFO for the core entitlement: states draw federal match on actual HCBS expenditures, then pay providers (agencies, direct care workers, MCOs) who serve eligible Medicaid beneficiaries. Distinct discretionary streams reach states differently: ARPA Section 9817 delivered a temporary 10-percentage-point FMAP bump on qualifying HCBS spend (April 1 2021 to March 31 2022) that states reinvested per a CMS-approved spending plan, and the Money Follows the Person demonstration awards capped competitive grants to single state Medicaid agencies via a grants.gov NOFO.
- $598.8Bobligated
- $428.4Breceived
- 65active awards
- 51recipients
- 56states
- 75counties
- Federal award record (USAspending)
- Authorizing statute
- Agency allocation table
- 11 primary documents, sealed
Authority
Medicaid Home & Community-Based Services is authorized by Social Security Act, Title XIX (Medicaid), Section 1915(c) (primary); related authorities Section 1915(i), 1915(j), 1915(k), and Section 1115 demonstrations, administered by HHS / CMS, as a mixed program. Statute.
Core HCBS: open-ended federal entitlement match at each state's FMAP on actual qualifying expenditures, with no fixed pool or formula allocation across states. ARPA Section 9817: temporary 10-percentage-point FMAP increase on qualifying HCBS expenditures (supplement-not-supplant; cumulative federal share capped at 95 percent), with the resulting state savings reinvested per a CMS-approved spending plan. MFP: competitive (discretionary) grant capped per the authorizing statute, awarded via NOFO with a per-award ceiling.
Allocations by jurisdiction
5 jurisdictions, from the published allocation table.
| Jurisdiction | Amount | Note |
|---|---|---|
| Illinois | $5.0M | Money Follows the Person demonstration expansion planning grant; up to 5,000,000; planning phase start September 1 2022. |
| Kansas | $5.0M | Money Follows the Person demonstration expansion planning grant; up to 5,000,000. |
| New Hampshire | $5.0M | Money Follows the Person demonstration expansion planning grant; up to 5,000,000. |
| American Samoa | $4.8M | First time MFP grants were made available to territories; amount of 4,750,000 reported by the territory's U.S. Representative (Radewagen). CMS press release states up to 5,000,000. |
| Puerto Rico | $5.0M | First time MFP grants were made available to territories; up to 5,000,000. |
Where the money lands
Place-of-performance obligations by state, with per-capita, sealed in the location chain.
| State | Obligated | Per capita |
|---|---|---|
| California | $453.3B | $11465.23 |
| New York | $276.1B | $13669.30 |
| Texas | $166.9B | $5726.18 |
| Pennsylvania | $138.8B | $10673.03 |
| Ohio | $121.4B | $10287.76 |
| Florida | $103.2B | $4790.07 |
| Illinois | $95.9B | $7484.86 |
| North Carolina | $94.7B | $9074.61 |
| Michigan | $87.9B | $8723.52 |
| Arizona | $81.1B | $11337.62 |
| Washington | $74.2B | $9628.51 |
| New Jersey | $74.1B | $7976.19 |
| Virginia | $73.2B | $8484.61 |
| Massachusetts | $71.6B | $10191.79 |
| Indiana | $69.9B | $10305.95 |
| Kentucky | $69.0B | $15323.85 |
| Louisiana | $65.6B | $14082.35 |
| Missouri | $58.4B | $9485.48 |
| Oregon | $57.8B | $13652.49 |
| Georgia | $56.7B | $5295.47 |
| Minnesota | $56.2B | $9845.72 |
| Maryland | $51.7B | $8366.99 |
| Tennessee | $48.0B | $6939.17 |
| Colorado | $43.7B | $7565.63 |
| Wisconsin | $42.1B | $7150.43 |
| New Mexico | $35.9B | $16961.08 |
| Oklahoma | $34.8B | $8791.25 |
| South Carolina | $33.6B | $6555.92 |
| Arkansas | $33.0B | $10956.48 |
| Connecticut | $32.8B | $9100.09 |
| Alabama | $29.4B | $5850.10 |
| Iowa | $28.1B | $8798.30 |
| Mississippi | $27.1B | $9167.51 |
| Nevada | $24.4B | $7844.65 |
| West Virginia | $22.1B | $12327.82 |
| Puerto Rico | $17.6B | $5367.99 |
| Kansas | $17.4B | $5928.94 |
| Utah | $17.2B | $5248.82 |
| District Of Columbia | $15.7B | $22763.40 |
| Maine | $15.5B | $11360.74 |
| Nebraska | $14.5B | $7372.98 |
| Idaho | $14.1B | $7685.83 |
| Rhode Island | $12.2B | $11085.18 |
| Alaska | $10.9B | $14903.59 |
| Delaware | $10.9B | $10996.24 |
| Hawaii | $10.7B | $7362.54 |
| Montana | $8.8B | $8118.57 |
| New Hampshire | $8.0B | $5796.24 |
| Vermont | $7.0B | $10942.57 |
| South Dakota | $5.1B | $5782.10 |
| North Dakota | $5.1B | $6542.33 |
| Wyoming | $2.2B | $3896.36 |
| Guam | $797.7M | $5185.51 |
| American Samoa | $470.6M | $9466.68 |
| U.S. Virgin Islands | $467.7M | $5367.04 |
| Northern Mariana Islands | $401.8M | $8489.00 |
Top recipients
| Recipient | Awards | Obligated | Received |
|---|---|---|---|
| HEALTH CARE SERVICES, CALIFORNIA DEPARTMENT OF | 2 | $83.4B | $65.0B |
| NYS DEPARTMENT OF HEALTH | 2 | $47.6B | $33.9B |
| VA DEPARTMENT OF MEDICAL ASSISTANCE SERVICE | 2 | $32.4B | $24.1B |
| HEALTH & HUMAN SVC COMMN TX | 2 | $30.2B | $20.8B |
| LOUSIANA DEPARTMENT OF HEALTH | 2 | $28.3B | $20.7B |
| PA DEPARTMENT OF HUMAN SERVICES | 2 | $25.3B | $18.3B |
| OHIO DEPARTMENT OF MEDICAID | 2 | $22.1B | $16.3B |
| DEPARTMENT OF SOCIAL & HEALTH SERVICES | 2 | $20.7B | $9.2B |
| NORTH CAROLINA DEPARTMENT OF HEALTH & HUMAN SERVICES | 2 | $19.1B | $13.5B |
| ILLINOIS DEPARTMENT OF HEALTHCARE & FAMILY SERVICES | 2 | $17.1B | $13.9B |
Source documents
11 primary documents, parsed and sealed by content hash.
- 42 U.S.C. 1396n - Compliance with State plan and payment provisions (Section 1915 of the Social Security Act, subsection (c) HCBS waivers) statute
- Home & Community-Based Services 1915(c) (CMS/Medicaid.gov program page) guidance
- Strengthening and Investing in HCBS for Medicaid Beneficiaries: ARPA of 2021 Section 9817 (CMS guidance page) guidance
- Implementation of ARPA Section 9817: Additional Support for Medicaid HCBS during COVID-19 (MACPAC issue brief) other, 12 pages
- Accessing Enhanced Federal Funding for HCBS Under the American Rescue Plan (SHVS / Manatt Health brief) other, 7 pages
- Money Follows the Person (MFP) Demonstration Program NOFO (CMS-1LI-22-001) nofo
- HHS Expands HCBS in Five New States and Territories (CMS press release, MFP expansion awards) fact-sheet
- Trends in Users and Expenditures for HCBS as a Share of Total Medicaid LTSS (CMS LTSS Rebalancing Brief, 2023 data) annual-report, 16 pages, 2 tables
- Medicaid Program; State Plan HCBS, 5-Year Period for Waivers, and HCBS Settings Requirements (HCBS Settings Final Rule) regulation
- U.S. Rep. Amata Radewagen: American Samoa $4.75M HHS/CMS MFP planning grant congressional-office
- CMS HCBS 101 presentation, Division of Long Term Services and Supports agency-presentation, 33 pages
Questions
- How does Medicaid Home & Community-Based Services money reach recipients?
- Money reaches recipients indirectly: the federal government pays each state its Federal Medical Assistance Percentage (FMAP) share (roughly 50 to 84 percent) of the cost of HCBS the state covers under a CMS-approved 1915(c) waiver, 1915(i)/(j)/(k) state plan option, or 1115 demonstration. There is no per-state allocation table and no NOFO for the core entitlement: states draw federal match on actual HCBS expenditures, then pay providers (agencies, direct care workers, MCOs) who serve eligible Medicaid beneficiaries. Distinct discretionary streams reach states differently: ARPA Section 9817 delivered a temporary 10-percentage-point FMAP bump on qualifying HCBS spend (April 1 2021 to March 31 2022) that states reinvested per a CMS-approved spending plan, and the Money Follows the Person demonstration awards capped competitive grants to single state Medicaid agencies via a grants.gov NOFO.
- How much federal funding does Medicaid Home & Community-Based Services represent?
- As of 2026-06-05, $598.8B was obligated across 65 active awards to 51 recipients in 56 states and 75 counties. This is a sealed point-in-time figure from USAspending, the federal system of record.
- What law authorizes Medicaid Home & Community-Based Services?
- Medicaid Home & Community-Based Services is authorized by Social Security Act, Title XIX (Medicaid), Section 1915(c) (primary); related authorities Section 1915(i), 1915(j), 1915(k), and Section 1115 demonstrations, administered by HHS / CMS.