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Outcomes of People who Receive HCBS: Still Room for Improvement

Posted on February 3, 2026

By Carli Friedman, CQL Director of Research

Home- and Community-Based Services (HCBS) play a critically important role in promoting the community integration and quality of life of people with disabilities. In 2014, the HCBS Settings Rule was introduced to ensure people receiving HCBS have choice, meaningful community inclusion, and that services and supports promoted person-centered outcomes. While the deadline for implementation was delayed a few times, the final deadline for compliance was March 17, 2023.

The aim of this study was to examine the outcomes and supports of people with disabilities who receive HCBS. To do so, I analyzed Personal Outcome Measures® data from 5,869 people with disabilities who received HCBS from 2016 to 2024.

People with disabilities who received HCBS had an average of 48% of outcomes present. Many of the outcomes that directly related to the HCBS Settings Rule, such as choosing where to work, choosing services, and choosing where and with whom to live, were present only about one-third of the time or less. Many people with disabilities who received HCBS also lacked person-centered supports in these very same areas of their lives, which likely contributes to a lack of outcomes.

Outcomes of People with Disabilities who Receive HCBS

outcomes of people with disabilities who receive HCBS. Are safe 78.0% Have the best possible health 66.0% Use their environments 65.0% Realize personal goals 61.5% Free from abuse and neglect 55.1% Are treated fairly 53.6% Respected 52.8% Interact w/members of community 52.2% Choose personal goals 51.9% Decide when share personal info 49.3% Exercise rights 47.4% Experience continuity and security 46.2% Live in integrated environments 45.7% Connected to natural support networks 43.3% Participate in the life of the community 40.2% Have intimate relationships 39.3% Have friends 35.8% Choose where to work 35.6% Perform different social roles 34.8% Choose services 31.0% Choose where and with whom to live 28.7%
Note. Light blue outcomes are those that more directly relate to the HCBS Settings Rule.

“HCBS and the HCBS Settings Rule has the potential to completely transform and improve the lives of HCBS recipients… Our findings suggest, many people with disabilities who receive HCBS are still not receiving high quality, person-centered services and person-centered supports. Much more work appears to be necessary to ensure the Settings Rule’s vision of choice and integration is met. This necessitates truly listening to people who receive services about what they want and need” (Friedman, 2025, p. 319).

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This article is a summary of the following journal manuscript: Friedman, C. (2025). Gaps between policy and practice: Outcomes and supports of people with disabilities who receive HCBS. Inclusion, 13(4), 308-321. https://doi.org/10.1352/2326-6988-13.4.308

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Disparities in Quality of Life and Quality of Supports in HCBS

The aim of this study was to examine disparities in quality of life and quality of supports among people with disabilities who receive HCBS. To do so, we analyzed Personal Outcome Measures® data from 5,869 adults with disabilities who received HCBS.

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