Defining Home- And Community-Based Services
Health Affairs, September 17, 2026
By Alexandra Bonardi, Valerie Bradley, Teresita Camacho-Gonsalves, and Sara Galantowicz
Home- and community-based services (HCBS) are essential to helping older adults and individuals with disabilities remain in their homes and communities rather than entering institutional settings, yet the term is interpreted in diverse ways across different populations and policy contexts. While it can broadly describe a wide array of supports—ranging from post-hospital home health and pediatric nursing to job coaching and respite care—it is frequently used more narrowly to refer specifically to state-level, Medicaid-waiver-funded programs. This fragmentation in definition and funding structures can obscure policy goals, complicate cross-sector alignment, and hinder consistent outcome measurement.
The conceptual roots of modern HCBS trace back to the 1960s, emerging alongside legislative milestones like the 1965 Older Americans Act as advocates increasingly questioned the heavy reliance on segregated custodial facilities for older adults and individuals with disabilities. Over the ensuing decades, policy frameworks expanded significantly, moving beyond basic nutritional and home-making assistance toward comprehensive, person-centered supports designed to foster community integration and autonomy. However, the absence of a universally agreed-upon definition has persisted as a structural hurdle for researchers, policymakers, and providers attempting to evaluate program efficacy.
Recognizing these challenges, ongoing initiatives—such as those led by The SCAN Foundation and stakeholder groups—are working to establish clearer terminology and core consensus standards for HCBS. Although a shared definition alone cannot resolve all operational and financial strains facing the sector, establishing common language is critical for accurately tracking impact, holding programs accountable, and ensuring the equitable distribution of resources for community living.