Waiver Extension

Amendment to Medicaid 1115 Waiver Extension Request: HCBS Personal Care Services in Acute Hospitals

As described in more detail below, in December 2022, Rhode Island submitted an extension request for the Rhode Island 1115 waiver (hereinafter “the Demonstration”), which has been in place since 2009 and authorizes Rhode Island’s entire Medicaid program. The State received a Completeness Letter for this extension request from CMS on January 5th, 2023.

On September 12, 2023, the State also submitted an amendment to the pending Demonstration extension request to continue to improve and support the health and well-being of beneficiaries receiving long-term services and supports (LTSS). Specifically, this amendment request seeks to allow the provision of Home and Community-Based Personal Care services in acute hospital settings, in order to improve outcomes for Medicaid HCBS waiver participants receiving care in acute hospital settings. This request is made pursuant to a specific state legislative directive in the enacted SFY24 budget. 

A full copy of the amendment request can be found here.

The amendment request included a summary of comments received from the public during the public notice and comment period, which ran from August 8, 2023 to September 8, 2023, together with the state’s responses, at Section 6.2. The state did not make any revisions to the amendment based on public feedback.

Medicaid 1115 Waiver Extension

Rhode Island operates the majority of its Medicaid program through an 1115 waiver. The 1115 waiver (“the Demonstration”) has been in place since 2009. The Demonstration provides medical and behavioral health services to eligible beneficiaries, as well as serving as a means for the state to test pilots and other cutting-edge projects to improve the Medicaid program. The Demonstration is currently authorized for five years through 2023. To continue the Demonstration for another five-year period, the state submitted an extension request to the Centers for Medicare and Medicaid Services (CMS) on December 22nd, 2022. A full copy of the waiver extension can be found here: Rhode Island 1115 Demonstration Waiver Extension Request

The extension request included several revisions in response to comments received from the public during the public notice and comment period which ran from September 30th to November 1st. A summary of the public comments is available in the extension request document at Section 7. The table below summarizes the changes made to the extension request based on feedback received from public comments:

Waiver Section

Description of Revisions to Waiver Draft

3.1.1 Home Stabilization Expansion

  • Remove exemption for Community Transition population
  • Change eligibility to eliminate health-related factors and add a housing-related factor to include individuals experiencing homelessness or at risk of homelessness
  • Expand target populations to add individuals and families experiencing/with a history of interpersonal or community violence
  • Add rent payments for six months and details regarding Healthy Home Goods

3.1.2 Restorative and Recuperative Care Pilot

  • Expand eligibility to individuals with a “health need that requires a safe and supportive environment,” including behavioral health

3.2 Outreach and Pre-Release Supports for Incarcerated Individuals

  • Clarify scope to include coverage of all services except those provided by DOC providers
  • Clarify population to include both adults and youth

3.3.3 Parents as Service Providers

  • Allow parents of all disabled adult children utilizing self-direction, not just those with intellectual and/or developmental disabilities, to act as service providers

Appendix A

  • Change the name of Adult Foster Care to Shared Living (Adult Foster Care)


Demonstration Extension Request


Current Demonstration Approval


Additional information about the Demonstration can be found at: 


For former 1115 Waivers, past extension application materials and background documents, and EOHHS Taskforce meetings, see Archive.