C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 441—SERVICES: REQUIREMENTS AND LIMITS APPLICABLE TO SPECIFIC SERVICES › Subpart H—Home and Community-Based Services Waivers for Individuals Age 65 or Older: Waiver Requirements

42 C.F.R. § 441.360

Limits on Federal financial participation (FFP)

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FFP for home and community-based services listed in § 440.181 of this subchapter is not available in expenditures for the following:

(a) Services furnished in a facility subject to the health and welfare requirements described in § 441.352(a) during any period in which the facility is found not to be in compliance with the applicable State requirements described in that section.

(b) The cost of room and board except when furnished as part of respite care services in a facility, approved by the State, that is not a private residence. For purposes of this subpart, “board” means three meals a day or any other full nutritional regimen. “Board” does not include meals, which do not comprise a full nutritional regimen, furnished as part of adult day health services.

(c) The portion of the cost of room and board attributed to unrelated, live-in personal caregivers when the waiver beneficiary lives in the caregiver's home or a residence owned or leased by the provider of the Medicaid services (the caregiver).

(d) Services that are not included in the approved State plan and not approved as waiver services by CMS.

(e) Services furnished to beneficiaries who are ineligible under the terms of the approved waiver.

(f) Services furnished by a provider when either the services or the provider do not meet the standards that are set by the State and included in the approved waiver.

(g) Services furnished to a beneficiary by his or her spouse.

Notes of Decisions
Cited in 5 cases (3 in the last 5 years), 2020–2025 · leading case: Karen Vaughn v. Jennifer Walthall, 968 F.3d 814 (7th Cir. 2020).
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Karen Vaughn v. Jennifer Walthall, 968 F.3d 814 (7th Cir. 2020). “See 42 C.F.R. § 441.360 (d) (“[Federal financial participation] for home and community‐based services … is not available in expenditures for … [s]ervices that are not included in the approved State plan and not approved as waiver services by CMS.”
Indiana Prot. & Advocacy Servs. Comm'n v. Indiana Fam. & Soc. Servs. Admin. (7th Cir. 2025). · cites it 2× “Knight 10 FSSA also cites 42 C.F.R. § 441.360 (d) as evidence that federal financial participation is not available for payments made to Ms.”
Indiana Prot. & Advocacy Servs. Comm'n v. Indiana Fam. & Soc. Servs. Admin. (7th Cir. 2025). · cites it 2× “Knight 10 FSSA also cites 42 C.F.R. § 441.360 (d) as evidence that federal financial participation is not available for payments made to Ms.”
Indiana Prot. & Advocacy Servs. Comm'n v. Indiana Fam. & Soc. Servs. Admin. (7th Cir. 2025). · cites it 2× “Knight 10 FSSA also cites 42 C.F.R. § 441.360 (d) as evidence that federal financial participation is not available for payments made to Ms.”
Karen Vaughn v. Jennifer Walthall (7th Cir. 2020). “See 42 C.F.R. § 441.360 (d) (“[Federal financial participation] for home and community‐based services … is not available in expenditures for … [s]ervices that are not included in the approved State plan and not approved as waiver services by CMS.”
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