The Missouri Department of Health and Senior Services (DHSS) is updating how it determines the nursing facility level of care (LOC) needed by older adults and adults with disabilities to qualify for Medicaid-funded long-term care, including Medicaid home and community-based services (HCBS). The state has not updated its HCBS eligibility requirements since 1982. After a series of stakeholder meetings to inform HCBS stakeholders of national best practices in LOC and obtain input on ways to address the problems with the current LOC system, DHSS drafted a new LOC algorithm. On December 26, 2018, DHSS informed HCBS provider . . .