Developmental Disabilities HCBS Waiver Consolidation

A state HHS agency managing $600M+ in Medicaid-funded intellectual and developmental disability services needed to consolidate multiple age-based HCBS waivers into a single program — while simultaneously modernizing the State-owned waiver management system that supports eligibility, service planning, and provider management for 6,200+ individuals across 100+ provider organizations. Over 2,500 people remained on waiting lists. The waiver environment was fragmented: differing eligibility rules created service gaps at age 21, workforce shortages had forced 90% of providers to stop accepting new referrals, and the state faced concurrent federal compliance deadlines across the HCBS Settings Rule and CMS Access Rule.

NXT established a Program Management Office as the central execution function. The PMO delivered:

• A cross-workstream program roadmap with sequenced milestones
• Governance structures enabling cross-agency decision-making
• Coordination across policy development, operations, and system implementation
• Continuous risk management and issue resolution
• Executive-level progress tracking and reporting

This structure created consistent decision-making and maintained forward momentum.