Gaps Between Policy and Practice: Outcomes and Supports of People With Disabilities Who Receive HCBS

The aim of this study was to examine the quality of life outcomes (personal outcomes) and person-centered supports of people with disabilities who receive Medicaid Home- and Community-Based Services (HCBS). We analyzed secondary Personal Outcome Measures® (POM) interview data from 5,869 people with disabilities who received Medicaid HCBS (2016–2024). People with disabilities who received HCBS had 48.4% of personal outcomes and 51.3% of person-centered organizational supports present, with indicators related to choice and control being the least present. Outcomes and supports were also less present after the HCBS Settings Rule implementation deadline. While the HCBS Settings Rule represents important values for choice and integration in theory, our findings suggest they are not frequently upheld and implemented on the ground.